Professional Development Subscription
Program Order Form Prepaid
(Goddard Schools)
Effective October 1, 2017
Form AP-09-003 (Rev. 1/1/13)
3059 Peachtree Industrial Blvd. ▪ Duluth, GA 30097 ▪ Phone 800-499-9907 ▪ Fax 877-259-1105 ▪
©Copyright 2011, ChildCare Education Institute. All rights reserved. CCEI provides training and education programs and makes no guarantee of
employment, promotion, or retention.
Multi-User License
Center/School/Corp Name: _________________________________________
Primary Contact/Admin: ____________________________________________
Title: ___________________________________________________________
Address: ________________________________________________________
City, State, Zip: ___________________________________________________
Phone: _________________________________________________________
Alternate Phone: __________________________________________________
: __________________________________________________________
Email Address: ___________________________________________________
Start Date: __________ End Date: __________
Admin Access: Yes No
Product Code
Product Description
Net Price
Center Based Unlimited Annual Subscription Plan
Center Based Licenses (minimum of 20 licenses required)
Grand Total
The disclosure of your Social Security Number is optional. ChildCare Education Institute (CCEI) will use this information only for administrative purposes, as more
specifically set forth in our privacy policy. Non-disclosure will not affect your order in any way.
See F.A.M.E. Terms and Agreements for program details.
Requires credit card or ACH draft. Delinquency will result in immediate suspension of account privileges and access to system inclusive of transcripts and certificates. A
$50.00 reinstatement fee will be imposed. Any account past due over 60 days will lose the access to the system and no reinstatement will be made.
Professional development, block hour purchases, and subscriptions (individual or center-based) are eligible for refunds within five (5) days of purchase IF no courses
have been accessed. Otherwise, no refunds will be issued. Any violation of the F.A.M.E. or Subscription Terms and Agreement will result in immediate cancellation of
access and no refunds will be given.
Credit Card: VISA Master Card AMEX Discover
By Check: Business Personal
Name on Card:
Name on Account:
Card Number:
Routing #:
Expiration Date: Security Code:
Account #: Check #:
Billing Address:
Bank Name:
Signature: X
Account Holder Address:
Account Holder Phone:
Signature: ______________________________________ Date: ______________________
$ 0.00
$ 0.00
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