On-Site Request Form

All on-site classes will be charged the cost of class per student (minimum of thirty students), cost of on-site proctor ($200.00 per class), cost of mileage to and from ISTC, and cost of SSV ($6.00 per person). If the on-site training location exceeds a 60-mile radius from an ISTC location, the customer may be charged additional cost based on the location of the training site. All on-site registration must be completed online by customer prior to on-site or an additional $125.00 administrative fee will be charged. If the customer wishes to pay the administrative fee, requiring ISTC to schedule, a list of individuals attending training must be submitted to training@istc.net by 12:00 PM (CST) the day before the scheduled class. The list must include the last six digits of the trainees’ social security number, name (first and last), and classes needed.

ISTC shall provide the following classes at the request of:

Company Name

Client ID

Company Contact Name

First Last

Primary Phone Number

Email

Requested Courses

Requested Date

Requested Time

: HH

MM

Number of Students

PO #

Address where class will be given

Street Address Address Line 2 City State ZIP Code

Insurance Requirements To Enter Facility

Specific PPE Requirements to enter facility

Company Representative Name

First Last

Company Representative Signature