Defensive Driving Student Contract
Please fill out the form in it's entirety. By submitting this form you are agreeing to all terms outlined in the contract below. Registration for this course will not be complete without full payment. Call 229-420-3590 if you have questions.
Full Name (as shown on Driver's License)
First Name
Middle Name
Last Name
Suffix
Street Address
Address Line 1
City
State
Zip Code
Date of Birth
*
.
Month
.
Day
Year
DL #
*
Phone Number
*
E-mail
*
Class Dates
October 18, 9am-4pm
November 15, 2025
9am-4pm
November 15, 2025
9M-4-PM
Course Intent
*
Insurance Reduction
Points Reduction
Reinstatement
Pts Reduction/ Reinstatement
Other
Upload a copy of student's Driver's License Or
Browse Files
Cancel
of
Take Photo of Permit/License
Please read and agree.
Contract not valid until SIGNED
*
Type a question
My Products
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Insurance Reduction Course (Spring Special)
$
75.00
Processing Fee
$
3.00
Defensive Driving
$
95.00
Total
$
0.00
Class Dates
October 11, 2025 9am-4pm
August 30, 2025 9am-4pm
September 20, 2025 9am-4pm
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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