3rd Party Payor

HarkinsSecurity.com 3rd Party Payor form. Company managers can use this form when paying an employee’s course enrollment fees. When submitting payment for a student, HarkinsSecurity.com will provide the beneficiary student with a coupon code to use during checkout when the student enrolls in a course and creates a student account.

Please identify the student for who you are providing enrollment fee payment and select the course(s) which you authorize the student to enroll.

PLEASE COMPLETE THE SECURE PAYMENT LINK BEFORE SUBMITTING YOUR ORDER FORM

Purpose *

• Paying course enrollment fee for the student named below
• Paying course enrollment fee the named student having already taken our course
• Paying specific amount as directed by Fred.

Student's Name *

First

Last

Student's Email *

Student's phone number *

Last 6 digits of Student's SS# *

Authorized courses for Student enrollment *

• MMPI (w/$30 discount applied) – $150.00
• Level II (only) course – $49.00
• Level III (only) course – $225.00
• Level III plus MMPI – $375.00
• Level III (only) Renewal – $99.00
• Level III Renewal plus MMPI – $249.00
• OC Spray (only) – $40.00
• Texas LTC incl Range Instruction (stand alone course) – $75.00
• Level II and LTC w/range – $124.00
• Level III and LTC (when also taking Level III) – $274.00
• Level III, LTC and MMPI – $424.00
• Level III Renewal and LTC – $149.00
• Level III Renewal, LTC and MMPI – $298.00
• Level II and Level III – $274.00
• Level II, Level III and MMPI – $424.00
• Level II, Level III plus OC Spray – $314.00
• Level II, Level III plus OC Spray and MMPI – $464.00
• Level II, Level III and LTC – $323.00
• Level II, Level III, LTC and MMPI – $473.00
• Level II, Level III, LTC and OC Spray – $363.00
• Level II, Level III, LTC, OC Spray and MMPI – $513.00
• 10hrs Defensive Tactics w/Range Instruction – $150.00
• Other Amount Specified – $1.00

When directed by Fred to use the “Other” selection, enter the full amount as directed by Fred on the credit card secure link field. For example, if Fred directs you to pay $150, select Other – $1 on this list and then enter $150 as the total amount to be charged on the credit card submitted.

NOTE: The $1 amount listed for other will NOT change, but you should enter the amount specified by Fred on the credit card submission form.

Total

$0.00

Payor's Name *

First

Last

Payor's Company Name

Payor's Email *

Payor's Phone Number

Submit

Click the Secure Payment Link (a new window will open) and remit the amount quoted by Fred or to remit payment for your invoice as shown in the total above. Credit card or e-Check payments options are available for your convenience.