Road Skills Test Contract

Driver's License Road Skills Test 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.
Full Name (as shown on Learner's License)

First NameMiddle NameLast NameSuffix
Address

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*

MonthDayYear
DL # (only state license)
No International License accepted.
Phone Number*

Area CodePhone Number
Emergency Phone No.*

Area CodePhone Number
E-mail*
Course Time*
Special Request/comment
Please read and agree.
Type a question
Signature of Student*

Clear
Name of Parent or Guardian of under age 21 students

First Name Last Name
Signature of Parent or Guardian (under age 21 students)

Clear
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Road Skills Test$45.00

Item subtotal:$0.00

Processing/Handling Fee$3.00

Total $0.00
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Driver's License Road Skills Test Contract