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HendyCompany Super Safety or Chicago Safety Institute

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Company:    _____________________ PO# ___________ Established Accounts attach Original Purchase Order by FAX

From: Dave Hendy Trainer Telephone 773-538-3333

 Intl  +1 312 543-6742

24Hr Toll Free 800-275-8239

FAX this to 773-538-8080 Email See above

Billing Address: Chicago Safety Institute PO Box 09282 Stock Yard Station Chicago, Illinois 60609

Chicago: I-90/94 Local Lanes Exit SOuth 47th Street go West to Halsted go North to

Training Location **4551 S. HALSTED CHICAGO, ILLINOIS 60609** East Side of Halsted, Park on Side street 46th for free!

We issue THE OSHA Construction 10 & 30 Hour CARD and certification for HAZWOPER for EMERGENCY RESPONDERS. Locations we can train at your site! Modern Facility training by arrangement for our customers always confirm start and scheduled times.

Always check please where Location of class is; at 4551 Halsted Chicago Il. or other Locations. HAZWOPER #1
1) Nationwide 2) Services: Safety, & Hygiene Services. 3) OSHA Authorized Outreach provider, AHA & NSC Community Ctr
Qty. Name of person attending Last 4 of SSN Course    Cost 











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rev 05/07
(Authorized Representative or Comptroller Signs for Payment of Services or your personal guarantee to pay [you agree to our terms and conditions and the credit card companies terms and conditions] for service or products. REGISTER MUST SIGN HERE Credit cards MC, VISA, American Express, and Discover, Government
Sign X_______________________________ Date __________   Thanks for your time to do paperwork properly!

Print Name Cardholder ______________________ Your Company ________________________ Card Yes ____ NO ____


 Address:                                               City:



Credit Card Type _______

Card Address:




 Credit Card Number ____________________________________  Expiration Date ___________

CV2 Number Back of Card Last 3 # _________ front of Amex Security Code _______

Desired Dates ___________________ Point Of Contact ________________________________

40-Hour HAZWOPER ___

24-Hour ERT ___

Supervisor 8 Hr  __

8 HR. Refresher ___

DOT Initial 24 Hr. ___

Confined Space ___

Disaster Site Worker 16 Hr ___

First Aid & Adult CPR___

Respirators ___

Excavation Safety ___

OSHA 10 Hr for Construction ___

Quantitative Fit Test ___ Cost Plus Respirator Porting___

 Excavation Safety ___

OSHA 10 Hour for General Industry ___

 Hazard Communication ___

Incident Command __

RCRA Management ___

Emergency Response Team  ERT Training ___

 Fork Lift Training ___

AHA First Aid/Adult CPR __ w/ AED Add __


Terms and conditions: Check course above! SERVICES REQUIRE this SIGNED REGISTRATION FORM faxed or scanned and sent to us, 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 (or maximum allowable by law) (No Exceptions) and [VOID ALL DISCOUNTS and for HAZWOPER 40 Hour cost shall be full price $950.00 .  If you don’t have a credit account here, Paying after the  first day of training is late registration $950.00 for 40-Hour Courses unless discounted 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, David 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.

Credit Card payment may show on any of these Hendy Company, Super Safety or Chicago Safety Institute. 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. Discounts may be available.  THE LEADER THE  REST WILL FOLLOW!

It's what you learn after you know it all that counts! 

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