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contact@noellerandall.com
All Internal Pages Utilized By Staff Are Now At https://portal.noellerandall.com
NuuRez Tours Fast Track Special
INTERNAL USE ONLY
This Form is
ONLY
to be used for events and qualified followups as directed by department managers and other senior staff.
Name
(Required)
First
Last
Mobile Phone
(Required)
This allows us to send messages via text to them, including support and course reminders.
Email
(Required)
This will also be their login for the course. Please verify the email before submitting.
Billing Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Program & Payment Information
Which Coach Is Closing This Deal:
(Required)
If you are a new coach and do not see your name in the list please alert IT immediately.
Select one of these options
Christy Stcyr-Allen
Dakelah Guishard
Kimone Campbell
KJ Steir
LaTeisha Cheney
Shane Williams
Payment Method
(Required)
For Payment Plans using an ACH Payment or Wire Transfer for the downpayment today, a card will still be needed to charge the monthly payment amount to.
Single Card
Multiple Cards
Check
Cash
Multiple Cards: Is this the last payment being processed for the student?
(Required)
When splitting into multiple cards, please select YES when this is the last card we are charging. Please note, if the sale includes a payment plan, the last card is the card that will be used for monthly payments.
Yes
No
Payment Type
(Required)
Pay In Full (PIF) Today
PIF Split Pay ($2997 Today, Balance in 14 days)
Payment Plan
Bringing a Partner/Friend?
(Required)
Yes
No
Partner Name
(Required)
First
Last
Partner Email
(Required)
Partner Mobile Phone
Pay In Full (PIF) Today
(Required)
Requires $7,997.00 one time payment at the time of purchase (or total amount paid today if split between multiple cards)
Price:
PIF Split Pay Down Payment
(Required)
Requires $2,997.00 down payment today and must pay the remaining $5,000 within 14 days or it will automatically convert to the Payment Plan option (making the total price $11,997)
Price:
Payment Plan - Initial Payment
(Required)
Requires $2,997 down payment today
Price:
Payment Plan - Monthly Payment
(Required)
Amount charged monthly for 9 payments (first payment is 30 days from today).
Price:
Multiple Cards - Payment Amount
(Required)
This is the amount that will be charged when you hit submit. This would be the downpayment amount for a payment plan OR if splitting between multiple cards, the amount that will be charged to this specific card.
Card Information
Credit Card
(Required)
Card Details
Cardholder Name
Single Card Payment
Split Card Payment
ACH Payment (Invoice)
Wire Payment
Noelle Randall
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