AL DMV Enrollment Verification

ALABAMA LAW ENFORCEMENT AGENCY ENROLLMENT / EXCLUSION FORM

To Implement Sections 16-28-40 through 16-28-45. Code of Alabama, 1975
Type all information as it should appear on your form. Please remember to capitalize.
Student Sex*
Student Last Name*
Student First Name*
Middle Initial ONLY
Date of Birth*

MonthDayYear
Date
Street*
City*
State*
Zip*
Parent Email*
example@example.com
Requesting Parent Name*

First NameLast Name
Parent Driver's License Upload (for verification of identity)*

Cancelof
Discipline Points
Today's Date

MonthDayYear
Date
My Products*
prevnext( X )
DMV Form (2 week turnaround time)
$ Free

EXPRESS DMV Form (2 day turnaround time)
$25.00

Total

$0.00

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.