On-Line Class Registration Page

STUDENT INFORMATION

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

EMPLOYER INFORMATION - (Optional)

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

CHOOSE YOUR COURSE:

Choose Course:
 
 
Date to Start:

PAYMENT INFORMATION

Credit Card Number: (Required)

Exp Date:
(Required)

CVV2 Code:
(Required) 

Full Billing Address:
(Required)

I have read and accept the terms described HERE.   Initial to Agree:   

 

 
Tuition Fees

 

Online Classes

Life: $350
Health: $350
Life & Health: $399
Property & Casualty: $499
   
Package Deals  
Life & Health & P&C $699


Enroll for Class Packages for
More Discounts!

 

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

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