NY and NJ - PRE-LICENSING - REGISTRATION
After completing form, click on the "Submit" button.
First:
Last:
Street:
City:
State:
Zip Code:
Work Phone:
Home Phone:
Mobile:
Email:
Soc. Sec. #:
License # (If Any):
License Type:
Expiration Date:
Birth Date:
Occupation:
Employer:
City:
State:
Zip Code:
PLEASE CHOOSE COURSE OF INTEREST:
NJ - SELF STUDY COURSE ONLY:
Life - $160
Accident & Health - $160
Life, Accident & Health - $195
Personal Lines - $209
Property & Casualty - $260
NJ - PRE-LICENSING - CLASSROOM/SELF STUDY COURSE:
Life - $305
Accident & Health - $305
Life, Accident & Health - $3855
Personal Lines - $405
Property & Casualty - $505
Location of Class:
Date of Class:
How did you hear of us?:
Advertising
Internet
NJ State Ins Dept
Referral
NY - PRE-LICENSING -CLASSROOM:
NY - Property Casualty Pre-Licensing Course - (Rock/Orange/Westchester) - $850.00
NY - Property Casualty Pre-Licensing Course - (NYC/Bklyn/Queens/LI/Albany) - $765.00
NY - Personal Lines - Pre-Licensing Course - $430.00
After completing form, click on the "Submit" button. Please click on "Course Pricing"
Course Pricing
to complete Registration
Focal Insurance Consulting - Insurance Education
P.O. Box 175 Pomona, NY 10970
Tel. # 845-354-2036 Fax # 845-354-4779
Copyright © 2005, Focal Insurance Consulting, All rights reserved
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