PAY BY CHECK FOR ONLINE ELECTRICIAN COURSE
NAME_____________________________________________________ PHONE #____________________________________
ADDRESS__________________________________________________ CITY____________________ ZIP______________

NAME ON LICENSE__________________________________________

TDLR LICENSE #_____________________________
LICENSE TYPE (circle one)          ME          MS          JE          JS          MN          RW                                                                        
EMAIL ADDRESS__________________________________________________________________________________________

MAIL THIS WITH $25  CHECK OR MONEY ORDER TO:     TXMHS     P.O. BOX 422     BEDFORD, TX 76095

AND TXMHS WILL EMAIL YOU A COUPON CODE TO TAKE ELECTRICIAN ONLINE COURSE