Contact Information

(*Required Fields)

First Name*

Last Name*

Email*

Confirm Email*

Landline Phone Number

Mobile*

I consent to receiving a confirmation text message and any important non-promotional communication texts from RBJ Financial Group

Billing Information

Street Address*

Street Address 2

City Name*

Zip Code*

(Please be mindful of any spaces in your Zip Code for specific countries)

Select Country*

My mailing address is different from my billing address

Mailing Address*

Mailing Address 2

Mailing City*

Mailing Zip Code*

(Please be mindful of any spaces in your Zip Code for specific countries)

Mailing Country*

Credit Card Information and Verification Form Only

Submitting this form will create an account with RBJ Financial Group to provide you access to our proprietary training and technology by verifying the card that will be used for your tuition and license fees.

Once verified, after submitting this form, your account profile will be created and in the next step, upon your authorization, your card will only be charged based on your agreement terms indicated below.

If you do have a separate agreement/amendment, please highlight it here for reference:

Divider Text

Card Number

CVC

Your card will not be charged when you submit this form.

item	qty	price	Total
itemCard Verification	qty1	price$0.00	Total$0.00

Subtotal	$0.00



Total	$0.00

SUBMIT

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