CCT Self Study Course Order Form: Print and fill out form. Mail form with your payment to: J&G Technology 2051 13th Ave W Shakopee, MN 55379 952-935-1108 <>Please Print. Name: ________________________________________                First           Initial                           Last                              Company: _____________________________________ Address: ______________________________________ City/State/Zip: __________________________________ Phone: _(           )________________________________ Email:  ________________________________________   Price: $395.00 Payment (check one):    ___ Company Check (Make checks payable to:  J&G Technology)                                   ___ Money Order (Payable to  J&G Technology)                                   ___ Cashiers Check (Payable to J&G Technology)                                   ___ Credit Card - Call  952-935-1108 with your order and number                                   ___  Request email invoice to enter credit card online   Signature: _______________________________________  Date ________________ TO PURCHASE BY CREDIT CARD: Call 952-935-1108 to process you credit card by phone or request an email invoice to enter card number on-line. THANK YOU FOR YOUR ORDER! YOU WILL RECEIVE EMAIL CONFIRMATION OF ORDER. Email: gary-meyer@comcast.net