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 Name
Middle Name
Last Name
Suffix
Street Address
Address Line 1
City
State
Zip Code
Date of Birth
*
.
Month
.
Day
Year
E-mail
*
example@example.com
Phone Number
*
Emergency Phone No.
*
DL # (only state license)
*
No International License accepted.
Permit Issue Date
*
-
Month
-
Day
Year
Date
Course Time
*
Please Select
10:00 am - 11:00 am
11:00 am - 12:00 pm
12:00 am - 1:00 pm
2:00 pm - 3:00 pm
3:00 pm - 4:00pm
4:00 pm - 5:00pm
Picture of Permit
*
Any Specific Date?
Please read and agree.
Type a question
Signature of Student
*
Name of Parent or Guardian of under age 21 students
First Name
Last Name
Signature of Parent or Guardian (under age 21 students)
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Road Skills Test
*Must have PERMIT for a year and a day UNDER 18. *Must complete 6 Hours of Private Lessons with OUR school for qualification.
$
50.00
Road Skills Test
Processing/Handling Fee
$
3.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
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