Please Mail both Page To: Atlantic Driving School, PO Box 5635 ,Mohave Valley, AZ 86446
928-715-3553 or text 928-727-2377 or e-mail email@example.com
You can also call in this information to register.
Certified Trainer: Glenda Webb
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. You can make advance payments before the class, the class must be paid in full on the day of class. Gift Certificates are available.
PAYMENT POLICY/ Waiver
Traffic Survival School should be paid in advance or at the door there is an additional $15.00 fee for the class. There is a completion Certificate given to the student at the completion of class. MVD is notified within 4 hours of completion.
Driving lessons you can pay in advance or on the first lesson. If you pay in advance for lessons and do not drive or attend TSS. 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 car is;
A white 4-door,2017 Ford Focus Hatchback
Look for the yellow roof sign!