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i <br /> Veeder-Root and Red Jacket Training Registration Instructions: <br /> Company Name P <br /> Franzen-Hill Corp. payment a ment to this form and mail to: <br /> Street <br /> Gilbarco Veeder-Root Training <br /> 11DD North J St. <br /> City ST Zip 12249 Collections Center Drive <br /> Tulare CA 93274 Chicago, IL 60693 <br /> Distributor/ASC Dumber <br /> m <br /> Phone Fax <br /> 559.688.2977 559.6B8.1467 Pricing <br /> co Contact Name e-mail (All prices are"per Student") <br /> N Amanda Hill amandahill@franzen-hill.com TLS Level l: $200 <br /> LO <br /> TLS Level 213: $500 <br /> Seminar (for Level 213, Level 4, and STP) $400(Veeder-Root ASC or Distributor) <br /> Location TLS Level 4: $250 <br /> LA CA $150(Veeder-Root ASC or Distributor <br /> Dates 10124103 RJ STP: $100 <br /> Student Name(s) Technician SSN or Certification / Class <br /> ( ) Certification Number Tis TLS Tis m <br /> = Level i Level 213 Level STP <br /> � <br /> 1 -1El1 „s F1 <br /> David Martin <br /> L <br /> 2 Junior 5inco - El El F F1 <br /> LL 3 ❑ El Q ❑ <br /> 4 ❑ D 1-1r1 <br /> r, <br /> 0 <br /> 5 El E F n <br /> LI <br /> CO <br /> 6 <br /> a <br /> © Please credit to account# 600420-605 <br /> a, <br />