Hendy Company Chicago Safety Institute™

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From: Manager ______________________	Phone _______________	FAX _______________	To: Director
Address _________________________________________________________________________________________

Billing Address: Chicago Safety Institute Post Office Box 09282, Chicago, Illinois 60609
TOLL FREE	TELEPHONE	24 Hour	PRINT OUT AND FAX TO
800-275-8239	773-538-3333	(312) 543-OSHA (6742)	OUR FAX 773-538-8080
#1 HAZWOPER	We can train at your site! Other Locations Too!
MAP I-90/94 Local Lanes Exit @ 35th or Pershing Road go West then go South on Halsted, Located 4551 S. Halsted Chicago, IL. 60609 Park on 46th ST side street off Halsted

Always check where Location of class is at, 4551 S. Halsted or other Locations. Classes start subject to change 7:30 AM 40 Hr. 4/10s or 5/8s 1st week each Month on Monday / 8 Hr. Attach additional sheet if Necessary.

1) Nationwide

2) Services: Safety, & Hygiene Services.

3) OSHA APPROVED

Terms and conditions: Check above! SERVICES REQUIRE A SIGNED REGISTRATION FORM , Valid ID required. Register for training. First time customers prepay at time of service. All courses are tentative until invoiced and payment is received. Cancellation Policy: FAX Cancel before fourteen (14) business days of class free thereafter no refunds,[ CANCELLATION WITHIN 14 DAYS WE CHARGE FULL PRICE] at start no exceptions without our written approval, no refunds in order to cover our time that was allocated or seats someone else could have had, no show no refund, books and the original certifications must be recovered. We reserve the right to cancel. This may be due to scheduling & to answer our client’s and Emergency Response needs, if WE CANCEL there is a FULL REFUND for cancellation. Cancellations and rescheduling fees apply (Example $50.00 with letter for dated after booking drug test failure & military activation excluded, Dr. Letter Medical Emergency, Court letter Jury Duty). We do not refund last minute project cancellations we have costs too. We can perform at your facility on a cost plus 15% basis. Pay by Corporate, or Certified Check, Money Order or Credit Card w/ processing fee. Seats guaranteed upon payment. Late payments ANY course incur interest 15 % Per Month (No Exceptions) and [VOID ALL DISCOUNTS and for HAZWOPER 40 Hour cost shall be full price $995.00 . If you don’t have a credit account here, Paying day of training is late registration $995.00 for 40-Hour Courses and pay $150 for 8 Hour Refresher. We reserve the right to adjust our prices may change same interest and terms for all other services. Client agrees to pay within Thirty Days (30 Days) past due an interest fee of 5 % Per Mo. or the highest allowed by the state the lower of the two shall apply, will be charged thereafter; non-payment subject to costs for recovery. We reserve the right to Sub-Contract all or a portion of our services. Contract for payment on demand unless indicated otherwise. [Client and all related persons being serviced by the authorized person signing agreeing to service shall hold harmless, indemnify, and defend Chicago Safety Institute, Hendy Company, Super Safety, premises, or any others e.g. instructors & contractors, property owners for any accidents, personal Injury, lost time, injuries, property damage and/or to be not liable for any circumstances.] Credit Card payment may show on any of these mentioned. If any part of this agreement shall be found not applicable it shall not restrict the other parts from being applicable all participants shall be covered by workers compensation or their own insurance or responsibility for and accident. [Warning actual work conditions may differ from training we DISCLAIM any written or spoken information and it may only be applicable at the time of training it is for educational purposes only]. This is because we do not supervise your employees or give medical physicals that is the employers responsibility you agree your employees are physically fit to get this training 29 CFR 1910.120(f). Discounts may be available. Contract of payment on demand unless indicated otherwise persons not authorized to sign assume personal responsibility to Pay.

[Client and all related parties by signing below agree to service shall hold harmless, indemnify, and defend Chicago Safety Institute or any others i.e. instructors, premises for any accidents, personal Injury, lost time, injuries, property damage and/or to be not liable for any circumstances. If any part of this agreement shall be found not applicable it shall not restrict the other parts from being applicable.] This is because we do not supervise your employees or give your employees medical physicals. Gov. / group discounts may be available. Any verbal request for services hereafter this agreement shall apply upon service of such verbal authorization by you or your company. We always require a signed registration but try to help in emergencies to register trainees. YOU AUTHORIZE US ACCESS TO YOUR SITE IF WE TRAIN THERE. Copyright © 2022 Privacy Notice

(Authorized Representative or Comptroller Signs for Payment of Services agreeing to above terms and conditions)

X ___________________________________Date _________________

Check Any Following for service request / PO Number _______________________
FAX THIS FORM BACK MUST HAVE SIGNATURE FOR PAYMENT AND SERVICES REQUEST
ATTACH LIST OR PO FOR SERVICES / SALES ITEMS: _________

40-Hour HAZWOPER ___

24-Hour___

Supervisors ___

8 HR. Refresher ___

Respirators ___

Confined Space ___

Hazard Communication ___

AHA First Aid __ CPR __

Fit Test ___

Excavation Safety ___

OSHA 10 Hour for General Industry ___

Fork Lift Training ___

MSHA ___

American Heart Assoc FA ___ CPR___

Emergency Contingency Planning ___

Emergency Response ___

OSHA 10 Hour for Construction ___

OTHER:________________________________

Your Company & Address:
City:	State:	Zip:	Dates Desired: ________

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