Online Driver Improvement Payment

Online Driver Improvement Clinic Payment Form
To benefit from the online course, you must be able to work independently and be comfortable using a computer or mobile device.

Your certificate will be delivered electronically by email. You can view and print the PDF on your own printer. If you do not have a printer, you can visit a public library, office supply store, UPS and FedEx, or your local copy & print shop.

YOU MUST COMPLETE THIS COURSE, INCLUDING THE FINAL EXAM, BY OCTOBER 27, 2023, DUE TO THE SCHOOL TEMPORARILY CLOSING AMIDST OWNERSHIP CHANGES.

Products:*

Online Driver Improvement Clinic

Computer-based, independent, and self-paced coursework.

$80.00

Total

$0.00

Credit Card

Apple Pay

Google Pay

Cash App Pay

Refund Policy Terms and Conditions*
Required Completion Date*
Student Full Legal Name*

First NameMiddle NameLast NameSuffix
Reason for taking the course:*
Birth Date*

MonthDayYear
Today's Date

MonthDayYear
Age
Phone Number*
Best number for communication.Format: (000) 000-0000.
Email*

Confirmation EmailBest email for updates and documents.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Guardian Name*
First and Last Name
MotherFatherOther
Parent or Guardian Phone*
Best number for communication.Format: (000) 000-0000.
Parent or Guardian Email*

Confirmation EmailBest email for updates and documents.
DMV (website, handout, etc.)Google searchYelp searchSocial mediaBusiness card or brochureRecommended by a friend or colleagueReturning customerOther
AFTER YOU SUBMIT THIS FORM:
- You will receive a copy of this form and a receipt by email.
- You will be automatically redirected to the online course website.
- DO NOT EXIT THE COURSE WEBSITE! Click the Sign Up button to create your student account before you exit the website.
If you exit the website before you create your student account, you will need to contact us at tndsiva@gmail.com to get the course website link. You cannot access the course without the link.
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Online Driver Improvement Clinic Payment Form