Pre-Licensing Registration Page


STUDENT INFORMATION

First Name: Last Name:
Email Address: Date of Birth:
Home Address: City, State, Zip:
Home Phone #: Cell Phone #:


EMPLOYER INFORMATION

Business Name: Contact Person:
Address: City, State, Zip:
Phone: Fax:


CLASS INFORMATION
(If you're enrolling for an online class, do NOT fill in session, location or date)

Choose Course: Choose Session:
Choose Location: Course Date:


PAYMENT INFORMATION

Credit Card #: Exp Date:
CVV2 Code: Billing Zip Code:
(Must Match Card)

Match Letters on Right:

USA    (This step prevents SPAM being sent to us)
I have read and accept the terms described HERE.  Initial to Agree: 
 
 


Tuition Fees
Life: $384
Health: $384
Life & Health: $436
Property: $450
Casualty: $450
Property & Casualty: $640
Title: $450
Bail Bonds: $425
Series 6: $399
Series 63: $199
Public Adjusters: $399
Class Softwares: $100

 

Online Classes

Life: $350
Health: $350
Life & Health: $399
Property & Casualty: $499

 

Student Links

Check Your C.E. Credits
Enroll for the State Exam
Renew Your License
Contact the Dept. of Insurance
Forms & Documents

Corporate Information

Mailing Address
P.O. Box 579
Lakehurst, NJ 08733-9998
Phone: (732) 370 - 8111
Fax: (732) 370 - 8112

Atlantic School of Insurance

Web Design by:
Web Designers LLC

Info@AtlanticSchool.com
www.AtlanticSchool.com
All Rights Reserved © 2017