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									2229 Canfield Avenue, Los Angeles, CA 90034 USA Phone: 310.815.9553 Fax: 1.310.815.9554

Accepted.com Fax Registration Form

Accepted.com

Fax Registration Form Application Services

Fax
To: Fax:

Accepted.com 1.310.815.9554

From: Pages: 5 Date:

Phone: 1.310.815.9553 Re:

Accepted.com Inquiry " For Review " Please Comment

" Urgent

Instructions:
Please print out this page, fill it out, and fax to 310-815-9554. An Accepted.com editor will contact you to begin work. If you have already completed our easy, online registration form (http:// accepted.com/services/register.aspx) please just provide name, phone number, and e-mail address in Section 1 and skip to Section 4. If you have not completed the registration form, please provide all requested information. Please note that your address must match the billing address on your credit card.

Section 1: Contact Information
Salutation: ___________ Address: Name: ______________________________________

______________________________________________________________ ______________________________________________________________

City: Country: Phone: E-mail:

________________ State: United States

_________

Zip:

__________________

Canada

Other: _______________________

______________________________________________________________ ______________________________________________________________

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Section 2: Academic Information
Undergraduate School: Major: ___________________________________________________________ GPA: _________________________ __________________

___________________________________

Degree: ___________________________________

Year of grad:

Other Degrees: _________________________________________________________________ Test Score: _____________________________________________________________________ Applying for admission (please provide date): __________________________________________ Program (check one): MBA or MBA/JD Medical Law Grad College Job Search

Other: _____________________________________ I would like to complete my first essay for (which school): ___________________________________ Target Date: ______________________________________________________________________ How did you hear about us? ________________________________________________________

Section 3: Terms and Agreement
Please initial to indicate agreement. Item 1 is required.

Your Initials __________ 1.

Accepted.com's Registration Terms I have read Accepted.com's policies at http://www.accepted.com/aboutus/policy.aspx and agree to the terms contained there. I hereby give Accepted.com permission to quote from my essay on its Web site and in its seminars, and/or other documentation provided that Accepted.com does not use my name. I hereby accept a free subscription to Accepted.com's monthly e-mail newsletter, Accepted.com Odds 'N Ends. I would like to receive notification of third-party programs, services, books, or other merchandise that we feel may be beneficial to our clients.

__________

2.

__________ __________

3. 4.

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Section 4: Package and Hourly Fees
Please select the desired services below, and initial items 1 - 3 to indicate your agreement to our terms. For information on prices and full service descriptions, please visit http://www.accepted.com/services/default.aspx.

Your Initials

Accepted.com's Terms of Service

__________

1.

I authorize Accepted.com to charge the credit card account provided below for the indicated services and for a total of US$ ___________. This work is for: _________________________________________________________. (Please provide the program or school names and if applicable the question numbers. i.e. AMCAS essay, law school personal statement, or Wharton 1 - 4.)

__________ __________

2. 3.

I understand that there is a minimum $200.00 charge. I have checked the services that I would like to purchase and provided the related quantities below.

QUANTITY: Qty: ______ Qty: ______

Essay Services Initial Essay Package Subsequent Essay Package Hourly Review and Editing $600.00 $450.00 $200.00/hour $3,300.00

Qty: ______

Buy 7, Get One Free Special (MBA Package) Special Essay Services

Qty: ______ Qty: ______ Qty: ______

Stanford Initial Essay Package Stanford Subsequent Essay Package Stanford MBA: Buy 7, Get One Free Package

$750.00 $600.00 $3,600.00

Qty: ______

Medical Applicant Secondary Essays

call for price

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Letters of Recommendation Qty: ______ Qty: ______ Generic Letter of Recommendation School-Specific Letter of Recommendation Letter of Recommendation (Hourly Editing ) Wait-List Letters and Services Qty: ______ Qty: ______ Wait-List Letter (New Clients) Wait-List Letter (Existing Clients) Wait-List Letter (Hourly Review and Editing) Additional Services Additional Consulting and Editing (Hourly) Admissions Consulting (Hourly) Review and Editing (Hourly) Résumé Services Qty: ______ Resume Package Resume Editing (Hourly) Resume/CVs (Medical and Scientific Fields) Qty: ______ Resume/CV Package Resume/CV Editing and Review (Hourly) $375.00 $200.00/hour $375.00 $200.00/hour $200.00/hour $200.00/hour $200.00/hour $450.00 $300.00 $200.00/hour $300.00 $450.00 $200.00/hour

Section 5: Comments
Please provide comments and/or clarification of your needs below (as applicable): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

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Section 6: Transaction Information

I am interested in: Hourly Editing Package Services Both Package and Hourly Services

Credit Card #

___________________________________________________________________

Expiration Date: ___________________________________________________________________ Card Type: Today's Date: VISA MasterCard Discover.

___________________________________________________________________

Your signature: ___________________________________________________________________

Please fax the completed form to Accepted.com at 310-815-9554. If you have any questions, please call 310-815-9553 or e-mail info@accepted.com.

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