TDA Application form

Online Driver Application Form

(THIS IS NOT AN APPLICATION FOR EMPLOYMENT, requires a valid license and proof thereof)
Date Leaving (City)*

MonthDayYear
Date
E-mail*
Destination*
City
Depart From*
City
Full Name*

PrefixFirst NameLast Name
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Reason for trip
Destination Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Destination Phone Number

Area CodePhone Number

Border crossing information

The following is required for proper border crossing documentation.
Driver Nationality
Place of Birth
Type of vehicle most familiar with
Please note that under section 24a(11) of the U.S. Immigration Act, it is illegal for a person to enter the States with a drug conviction, unless that person applies for a waiver.

Possession of the smallest amount of drugs or drug accessories will result in serious charges levied by the U.S. Customs - possible imprisonment - certain heavy fines and seizure of your possessions and the car.
YesNo
YesNo

Identification information - This is for identification and emergency purposes only.

Reminder - THIS IS NOT AN APPLICATION FOR EMPLOYMENT.
Driver Description
Spouse Contact Information
YesNo
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Next of Kin / Emergency Contact Information
Next of Kin Name*

First NameLast Name
Relationship to driver*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Name

First NameLast Name
Should be Empty:

Online Driver Application Form