Classroom Training ONLY

Payment Options

Credit Card Check payment (Payment required for every order, must receive within 48 hours for order to be complete. We are unable to hold a seat if not received within 48 hours. )

Dates

September 24 - 27, 2019 November 23 - 26, 2019 December 27 - 30, 2019

Dates

September 24 - 27, 2019 -- Full Payment $ 250.00

September 24 - 27, 2019 -- 50% Payment $ 125.00

November 23 - 26, 2019 -- Full Payment $ 250.00

November 23 - 26, 2019 -- 50% Payment $ 125.00

December 27 - 30, ,2019 -- Full Payment $ 250.00

December 27 - 30, 2019 -- 50% Payment $ 125.00

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

General Information

Parent/Guardian (if applicable)

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number

E-mail *

Student Information

Driver's Name *

First Name Last Name

Birth Date *

Month Day Year

School Name

Grade

Gender *

Male Female

Student Permit/License # *

If they don't have permit yet type N/A

Expiration Date

Date Date Picker Icon

Student's Phone

Area Code Phone Number

Does the driver have any special accommodations we should be aware of (504 Plan, IEP, etc.)? If yes, please describe. *

Special Accommodations Information

Refund Policy

Towne Lake Driving School does not offer refunds. All contracts are good for one (1) year.

Confirmation

BY CLICKING THE SUBMIT BUTTON, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. I ALSO CONFIRM THAT I AGREE WITH TOWNE LAKE DRIVING SCHOOL'S PRIVACY POLICY.

Classroom Training ONLY - 30-Hour