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Partner Registration Form
eHome America Partner Registration Form
Other NWO Affiliation
Are you HUD Approved?*
Company Phone Number*
Primary Contact Name for eHome Clients*
Primary Contact email address*
Administrators Name (s) for eHome Clients*
Administrators email address(s)*
We will email a copy of our logo to firstname.lastname@example.org
We give eHome America permission to copy our logo from our web site (usually poorer quality)
We require students to contact us prior to printing their certificate of completion
We require a borrower and co-borrower to register and pay separately
Automatic discount for co-borrower
Registration Fee: (Select one only)*
USD 1000 fee (population served above 50,000 people (USD 25 admin fee per client)
USD 500 fee (population served below 50,000 people (USD 25 admin fee per client)
USD 200 fee (no population requirement, but USD 30 admin fee per client
How will you pay your registraton fee?*
We will send a check to pay the registration fee
We would like an electronic invoice we could pay online
Course price to charge clients (Minimum $99 - can discount with coupons)*
Please indicate the price you want to charge clients for the course if greater than the $99 base price.
When a client completes the course, give us a short congratulatory statement to provide to them with any next steps they need to take to receive their certificate.
Do you want to offer a discount coupon to reduce the course fee for a client/group of clients?*
Coupon code value
You can discount the course fee if you wish via coupon codes that you can give to your clients. Coupon codes can only be discounted down to the admin fee. If you want to discount including the admin fee, contact us directly.
Are you a member of an intermediary?
If you are, what is the name of the intermediary?
Company Website Address
Do you require a borrower and a coborrower to register and pay separately?