Mí Casa Enterprises

REGISTRATION  FORM

(Please type or print.  Print out this form and mail it with your check to the mailing address below.)

Name:  __________________________Soc. Sec. #:_____-___-_____

Name exactly as it should be printed on completion certificate:

 ________________________________________________________

Address:  ________________________E-Mail: __________________

City:__________________State: ________________ Zip: __________

Home Phone #:___________________ Cell #:____________________

Work Phone #:___________________

Tuition Fee: 

$100.00   Payment is due at registration submission and is non-transferable and/or non-refundable.

$50.00    Payment for any of the other business partners (or spouse) to have a certificate in their name

(all of the work must be done by that individual also).

** This is the Financial Management Training Program approved by the Farm Service Agency to meet the required Farmer Borrower Training Requirements. This Vendor makes no other claims or warranties, either stated or implied.**

FSA Information:

State:_________________  Dist/County Office:___________________

County Supervisor:__________________ Phone:__________________

Fax: __________________

Mailing Address of Office: ___________________________________

                                         ___________________________________

                                         ___________________________________

Signature: ________________________________________________

Mail to:            Karen Harlan

                        P.O. Box 1393

                        Seagraves, TX  79359

                        Fax #:  (806) 546-0079

                        (806) 546-0409

Work to be Submitted

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