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Online Medical Coding Training Course - Quick Payment Plan Enrollment Form

This is a Quick Payment Plan Enrollment Form. If you require or desire different terms than those listed below, please refer to our main payment plan options page. The following constitutes a Promissory Note for an Installment Plan Loan.
PROMISSORY NOTE

REMEMBER TO PRINT A COPY OF THIS FORM BEFORE SUBMITTING
The Medical Coding Training Course includes the following:
  • Online Access to the Course for 1 Year


  • Printed Course Materials


  • Medical Coding Module


  • Medical Terminology Module


  • Health Insurance Specialist Module


  • ICD Diagnostic Coding Book


  • CPT Procedural Coding Book


    • Add-Ons Allowed*:

  • AlphaII Coding Software - Single User License - $1,295.00


  • Surgical Compendium w/CD-ROM - $89.95
 QUICK PAYMENT PLAN TERMS

The following describes the terms for the Online Coding Course Only:

  • 7 Month Plan = [Initial Down Payment + 6 Installments]


  • Course Cost = $1,989.00
  • Loan Origination Fee = $100.00
  • Course Registration Fee = $45.00
  • Shipping Charges = $25.00
  • Subtotal: $2,159.00


  • Less Initial Down Payment = ($200.00)


  • Total Amount Financed: $1,959.00


  • Total Finance Charges = $86.59 [APR Rate = 15%]


  • 6 Monthly Installments = $340.93 ea.


  • Total Cost = $2,245.59


    • LATE FEES: $5.00 or 5% of the installment payment amount, whichever is greater. COLLECTION FEES: As may be applicable in the event of default.

    *Course Add-Ons for Surgical Compendium w/CD-ROM and the AlphaII Coding Software System (Single User License), may not be included within the payment plan and will be added to the initial Down Payment if selected. Example: With the AlphaII Coding Software, the Initial Down Payment would be $200.00 + $1,295.00 = $1,495.00, with the remaining 6 installments @ $427.60 remaining the same as indicated in the TERMS.
    SECTION 1: Select Your Training Course Option. Check the course enrollment that want below:

    Medical Coding Course Only - Total Cost: $2,245.59 - (Down Payment = $200.00 + 6 Installments of $340.93 + 6 Installments of $340.93)

    Medical Coding + Surgical Compendium w/CD-ROM** - Total Cost: $2,335.54 - (Down Payment = $289.95 + 6 Installments of $340.93 + 6 Installments of $340.93)

    Medical Coding + add Single User AlphaII Coding Software System** - Total Cost: $3,540.59 - (Down Payment = $1,495.00 + 6 Installments of $340.93 + 6 Installments of $340.93)

    Medical Coding + add Surgical Compendium w/CD-ROM + add Single User AlphaII Coding Software System** - Total Cost: $3,630.54 - (Down Payment = $1,584.95 + 6 Installments of $340.93)

    **The AlphaII Coding Software System and the Surgical Compendium are NOT required to complete the course. This software is used by professional medical coders across the country and you can always come back and order it later if you should decide you want it after completing the course.

    A Meditec.com Enrollment Coordinator will contact you by phone to confirm your selection and to obtain the necessary Credit/Debit Card numbers necessary to initiate this order, and to process your initial down payment.     		SECTION 2: Your Name and Contact Information: First Name:
    Last Name:

    Provide Your Physical Address, not a P.O. Box **
    Street Address:
    City:
    State:
    Zip Code:

    Daytime Phone:
    Evening Phone:

    Email Address:

    Best Time To Call You:
    9 AM - Noon
    Noon to 5 PM
    Any time between 9 AM and 9 PM

    Your Time Zone:

    **If you need to provide an alternate address for shipping, please provide this information to the Enrollment Coordinator when you are contacted to verify the order.
    SECTION 3: Indicate Your Payment Type Preference:

    (Check One) -- NOTE: For Debit Cards, multiple transactions may be required in order to process the full amount of the down payment and/or monthly installments.

    For Certified Checks, we will pend credit and/or shipping of materials for 10 business days to allow for the check to clear our merchant bank account.

    We do not accept COD, personal checks, bank drafts, corporate checks, or money orders.

    I will use a Credit Card
    I will use a Debit Card
    I will send a Certified Check
    I will use a combination of Credit/Debit and/or Certified Checks

    Credit and Debit Card information will be gathered from you at the time of confirmation of your order by telephone. Make Certified Checks payable to: Meditec.com     		SECTION 4: Acknowledgement - PROMISORY NOTE: Electronic Signature Verification Is Required...

    Electronic Certification - I do hereby certify that I am at least 18 years of age, and that by submitting this enrollment form, I am undertaking a contractual obligation by entering into an installment payment plan agreement with Meditec.com. This is a PROMISSORY NOTE.

    Electronic Authorization - I do hereby authorize Meditec.com to initiate an installment loan in accordance with the terms defined herein above and to bill me in accordance with the selections I have made within this enrollment form. I agree to pay 100% of all charges, including all finance charges, late fees and/or collection costs which may be added in the event of untimely payment or default of this PROMISSORY NOTE. I understand that Meditec.com will take my initial Down Payment prior to shipping any materials or setting up my online account, and the date upon which that down payment is paid, shall be the origination date of this PROMISSORY NOTE. I understand that monthly installments will be billed/charged (due) every 30 days, and must be received within 10 business days of the due date in order to be timely received and/or to avoid late charges.

    Verify:

    AGE:
    DOB:[MM-DD-YYYY]
    [Do NOT include Credit/Debit Card Numbers, or other financial data. An Enrollment Coordinator will follow up with you by telephone to confirm this order and to obtain the additional information needed to process your down payment and the monthly installments.]

    If you have any other Comments or Questions, please list them below:

    PRINT A COPY OF THIS FORM BEFORE YOU SUBMIT IT

    THEN...
    OR


    		Page Last Revised: Wednesday, 27-Aug-2008 18:28:57 GMT