Training Booking Form

Your / Company Details

Your Name *

Company Name

CITB Levy Reg. Number

Single Line Text

Email *

Phone Number *

Address (For certificate) *

Address Line 2

City *

Post Code

Is the invoice address different?

No

Yes

Discount Code

Invoice Address line 1

Invoice Address line 2

Invoice Address City

Invoice Address Post Code

Course Details

Training Course / Service Title

Date(s)

Start Time

Qty / Candidates

Total Cost (plus VAT)

Candidates Names(s) / Notes

Payment Method

Select one payment method below NOTE: If accepting a discount you must provide card details to make payment immediately. *

Electronic bank transfer

Card

Please make your company name as the reference and make payment to:
Courtley Account Number: 10111530 Sort code: 16-24-06

Payment Ref (use company name)

Date of payment

Card number

Expiry Date

CVS

Postcode

Name on Card

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Your / Company Details

Course Details

Payment Method

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