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eHome America Partner Registration Form
Company Name :
required
Please enter the company name
NeighborWorks Organization :
required
--Select Option--
Yes
No
Please select the neighborworks organization
Other NWO Affliation :
Are you HUD approved :
required
--Select Option--
Yes
No
Please select the HUD approved
Company Address :
required
Please enter the company address
Company Phone Number :
required (ex: 1234567890)
Please enter the phone number
Agency Type :
required
--Select Option--
Non - Profit
HFA
Lender
Other
Primary Contact Name for ehome Clients :
required
Please enter the contact name
Primary Contact email Address :
required
Please enter the contact email address
Company Website Address :
Administrators Name(s) for eHome client :
required
Please enter the administrators Name(s) for eHome client
Administrators email address(s) :
required
Please enter the administrators email address(s)
Agency Description :
required
Please enter the agency description
Company Logo :
required
--Select Option--
We will email a copy of our logo to support@ehomeamerica.org
We give eHome America permission to copy our logo from our web site (usually poorer quality)
Please select company logo options
We require students to contact us prior to printing their certificate of completion :
required
--Select Option--
Yes
No
Please select an option
We require a borrower and co-borrower to register and pay separately :
--Select Option--
Yes
No
Automatic discount for co-borrower :
Registration Fee (Select one only) :
required
--Select Option--
USD 1000 fee (population served above 50,000 people (USD 27.50 admin fee per client)
USD 500 fee (population served below 50,000 people (USD 27.50 admin fee per client)
USD 200 fee (no population requirement, but USD 32.50 admin fee per client)
Please select registration fee
How will you pay your registration fee? :
required
--Select Option--
We will send a check to pay the registration fee (if you want an invoice let us know). Make check out to Community Ventures Corporation.
We would like an electronic invoice we could pay online.
Please select registration fee
Course price to charge clients (Minimum $99 - can discount with coupons) :
required
Please indicate the price you want to charge clients for the course if greater than $99 base price.
Please enter the Course price to charge clients
Congratulatory Statement :
required
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.
Please enter the congratulatory statement
Do you want to offer a discount coupon to reduce the course fee for a client/ group of clients? :
required
--Select Option--
Yes
No
Please select any option
Coupon 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? :
--Select Option--
Yes
No
If you are, what is the name of the intermediary? :
