Lifting Restrictions registration Form

Lifting Restrictions Registration Form
Type of Restriction*
Have you previously taken the CDL test exam? *
If so when and where?
Name as it appears on learners permit*
Birthdate mm/dd/yyyy*
Plesase enter a valid E-mail address for test scheduling purposes*
Home/Cell phone*
CLP Information
Learners permit DL number (Example: A123-4567-8910-00)*
License Class (A,B,C)*
Learners permit Issue date*
Learners permit Expiration date*
Address listed on Learners permit*
City, State, Zip*
Learners permit Endorsements
Air brake restriction? (On back of CLP)

YesNo
Medical variance (On back of CLP) If none leave field blank
Please verify from the website that you are within the meeting area of the testing locations. If you are outside the Milwaukee area please be sure to fill in additional comments or questions below and we will get back to you promptly.
Vehicle Information (please only fill out if providing vehicle for test)
Company Name Address, Zip (if applicable)
Tow Unit GVWR/GCWR (found on driver side door frame)
Tow unit transmission

AutoManual
Tow Unit Brake System

HydraulicAir
Coupling System

Fifth WheelPintle HookGoose NeckBall
Trailer GVWR (found on manufactures plate to frame)
Trailer Braking system

ElectricAir
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:

Lifting Restrictions Registration Form