Retest Registration Form

Retest Registration Form
* Retests will be scheduled as time permits and at location examiner is already scheduled to test at. Scheduler will discuss when and where test will be conducted. Be prepared to have qualified CDL driver accompany you to test location.

At a minimum please fill out your name, birthdate, email address and phone number below. Only fill out the instructional permit and vehicle information sections of this form if the information has changed since your original test.
Name as it appears on your Learners Permit
Birthdate mm/dd/yyyy
E-mail address
Home/Cell phone
I acknowledge that I will be bringing the MV3556 form to the retest that was given to me on the date of my last test
Learners permit DL number (Example; A123-4567-8910-00)
Class of License (A,B,C)
Learners permit Issue date
Learners permti Expiration date (180 days from issue date)
Address listed on permit
City, State, Zip
Learners permit Endorsements
Air brake restriction? (On back of CLP)
Medical variance (On back of CLP) If none leave field blank
Vehicle Information (only fill out if vehicle is different than the one you used for the original test)
Do you have a vehicle available?
Company Name Address, Zip (if applicable)
Tow Unit GVWR/GCWR (found on driver side door frame)
Tow unit transmission
Tow Unit Brake System
Coupling System
Trailer GVWR (found on manufactures plate to frame)
Trailer Braking system
Number of Passengers (bus only)
Additonal comments or questions
Name of person paying by Credit Card or Check (if different from person being tested)
Should be Empty:

Retest Registration Form

Vehicle Information (only fill out if vehicle is different than the one you used for the original test)