City College Southampton

(adult)

Course Booking : Step 1 - Your Details

If you would like to book a City College Course, please fill in the form below. Once you have completed this form you will be directed to our secure payment system to pay for your chosen course.

Please note: Certain information is mandatory on this form to ensure we can process your order quickly and efficiently, these fields are denoted by a purple background.

Your Course

Course Information:

Course Title:

Start Date:

[starts in days]

Tuition Fees (£):

£0.00

Exam Fee (£):

£0.00

Total Cost:

£0.00

Your Details

Title:

Firstname(s):

Surname:

Date of Birth:

Gender:

Your Address : Enter PostCode and hit 'GO'

Address:*

Address 2::*

Address 3::*

Town / City:*

County:*

Post Code:*

Country:*

* If paying by card please ensure address details match card details, if not tick box below.
Please tick the box if the payment card details are different, you will then be able to enter a different address in payment area.

Your Contact Details

UK Telephone:

UK Mobile:

Email:

Residency Status & Ethnicity

Country where you normally live:

Note: Domicile Country is where you normally live / are ordinarily resident.

Lived In EU 3 Years:

Date Of Arrival:

Arrival from Country:

Ethnic Origin:

Support Information - How Can We Help...

As a College we aim to bring success to all, regardless of their physical disabilities, emotional, personal or learning difficulties. If you feel you need any additional support relating to a physical, medical or learning need, we are here to help. Please select below if you do/do not wish to receive additional information relating to the support we offer, and for the opportunity to disclose any relevant support needs you may have.

Receive Support Information:

Do you have a Disability?:

Do you have a Learning Difficulty?:

How did you hear about us?

Please Choose:

Payment Method

We currently offer two payment methods for our full cost courses, they are as follows:
Pay Online by Credit or debit card online, we accept all major credit cards (Visa, MasterCard, Maestro and Solo).
Pay by Invoice - The invoice will be sent to the address entered (more info required)

Choose Payment Method:

The Invoicing option is NOT available as this course starts in days time.
We only accept invoices for courses that starting in 14 days or more.

Invoice Details
Account / Sponsor ID:*	*Student ID / Sponsor ID will only be available if you or your company have attended a course before.
Purchase Order No:*	*If required by your Compny, please enter a purchase order number.
Company:
Invoice Total:	£0.00
Invoice Address
Use Address Above:
Address:
Address 2:
Address 3:
Town / City:
Post Code:

Terms & Conditions:

I confirm that I have read the and agree to the Terms & Conditions for Online Orders.

City College Southampton

Your Course

Your Details

Your Address : Enter PostCode and hit 'GO'

Your Contact Details

Residency Status & Ethnicity

Support Information - How Can We Help...

How did you hear about us?

Payment Method

Invoice Details

Invoice Address