M Casa Enterprises

REGISTRATION  FORM

(Please type or print.  Print out this form and mail it with your check to the mailing address below.)

 

Name:  __________________________Soc. Sec. #:_____-___-_____

 

Name exactly as it should be printed on completion certificate:

 ________________________________________________________

 

Address:  ________________________E-Mail: __________________

 

City:__________________State: ________________ Zip: __________

 

Home Phone #:___________________ Cell #:____________________

 

Work Phone #:___________________

 

Tuition Fee: 

$100.00   Payment is due at registration submission and is non-transferable and/or non-refundable.

$50.00    Payment for any of the other business partners (or spouse) to have a certificate in their name

(all of the work must be done by that individual also).

 

** This is the Financial Management Training Program approved by the Farm Service Agency to meet the required Farmer Borrower Training Requirements. This Vendor makes no other claims or warranties, either stated or implied.**

 

FSA Information:

 

State:_________________  Dist/County Office:___________________

 

County Supervisor:__________________ Phone:__________________

 

Fax: __________________

 

Mailing Address of Office: ___________________________________

                                         ___________________________________

                                         ___________________________________

 

 

Signature: ________________________________________________

 

Mail to:            Karen Harlan

                        P.O. Box 1393

                        Seagraves, TX  79359

                        Fax #:  (806) 546-0079

                        (806) 546-0409

 

Work to be Submitted

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