Please Mail This Page To:
Please print both pages :)))
Atlantic Driving School PO Box 5635 Mohave Valley, AZ 86446 …928-715-3553 or text 928-727-2377
You can also call in this information, to register! Classes book FAST!!!
Certified Trainer: Glenda Webb for information: e-mail: email@example.com
Driver Ed 30 hour on line program_____, 6 hr drive _______,8 hrs drive______, 10 hrs drive time______ Traffic School_________
First & Last Name________________________________________________________________
City & State, zip________________________________________________________________________
Cell phone number:_____________________________________________________________________
Date of Birth__________________________________________________________________________
Credit Card #__________________________________________________________________________
Last 3 # on back of card_________________________________________________________________
How much do you want to charge?________________________________________________________
Payments include payment plans. Checks, Money Order, Master Card/Visa.(There is a $5.00 service charge for cards) You can make advance payments as many as you want before the class, the class must be paid in full on the day of class. Mail to the PO Box, top of page. Gift Certificates are available.
PAYMENT POLICY/ Waiver
Traffic Survival School can be paid in advance or at the door for the class. There is a completion Certificate given to the student at the completion of class. MVD is notified within 4 hours of that completion.
Classroom or driving it is suggested to pay in advance. (Payments can be made prior to the class.) But it is possible to pay for the service at the time of that service. If you pay in advance for that service and do not attend the class or drive time. We will hold the money and do the service in the future for one year of the date of payment. Atlantic Driving School will call you 3 times by phone with the number that you provided to reschedule the service. After that, you are responsible to contact us. Atlantic Driving School cannot legally guarantee that you will learn the correct skills for the classroom or driving skills. But we have a VERY high percentage that do.
Refunding: If you request a refund for services paid for but have not received. We will subtract a 25% charge of the total cost paid as a handling fee and mail you the difference.
In no event shall Atlantic Driving School be liable for any consequences or incident damages due to the instructions, classroom or in car, The total liability of Atlantic Driving School shall not exceed the total paid to Atlantic Driving School for services rendered.
I agree that the actual fees paid on my signed invoice reflect this limited liability and allocation of risk.
Signature _____________________________________________________________ Date____________________________
If under 18 must be signed by parent or legal guardian.
This form MUST be brought to your first session.
Atlantic’s School cars are:
All cars are white 4-door,2014 Ford Focus & 2014 Chevy Sonic Sentra,
Look for the yellow roof sign!