Name_____________ Inv#_______________ Permit_____________________ Exp. Date_________
^----Office Use Only---^
How did you hear about us? [] Internet
[] Direct Mail
1st Class Driving School, Inc. 3550 West 145th St Burnsville, MN 55306
[] Yellow Pages [] Other [] Word of Mouth
_____________________________________________________________________________ First Middle Last Name _____________________________________________________________________________ Address City Zip DOB______/_______/_______ Home # (_____)______________ Cell # (____)_______________ Email Address (for BTW confirm)_____________________________________________________ 1st Class Driving School, Inc. does hereby agree to teach for a fee;___hours (max of 30, min of 6 hours if under 18) of one-on-one Behind the Wheel (BTW) Instruction to the person whose name and address appears on this Contract. If said person is a minor child, a parent or guardian must sign this contract for verification/agreement. If the student does not show, does not have his/her Instruction permit, or cancels st a BTW appointment without giving 1 Class Driving School, Inc. a 24-hour notice, the student/parent will be charged an extra $45.00 for each missed lesson. In the event that a student is unable to finish class due to sickness or family emergency, they will be refunded the prorated portion of the unattended class. If the contract expires any unused instruction will be forfeited. 1 st Class Driving School, Inc. does not guarantee a Driver License for any student. This contract expires one year from the date of signature. Parent/Guardian Signature_____________________________________Date:______________ Student Signature____________________________________________Date:______________ Authorized Personnel Signature_________________________________Date:______________ Amount Paid $_________ Date of Pymt ___________ Pymt Type_________ Balance $__________ ******************************************************************** **********************************************
BTW #1 __ Pretrip __ Right Turn __ Left Turn __ Stop Sign __ Clear Inter __ Parallel Park __ 90 Deg. Back __ Hill Park __Traffic Light __ Lane Chngs BTW #2 __ On Ramp __ Clear Inter __ Follow Dist __ Speed __Blind Spot __ Off Ramp __ Big Picture __ Lane Chngs __ X walk __ HELT BTW #3 __ 1way > 1way __ 1way > 2way __ Clear Inter __ Unmark Lane __ No Turn on Red __ 2way > 1way __ Freeway __ Space Cushion __ Observations __ Traffic Flow __ WC
Comments:
Credit Card Payment Agreement
Down Payment Payment #2 Payment #3 $_______ $_______ $_______
I agree to have the above payments charged to the following credit card number based on the mutually agreed upon dates for BTW as well as the initial payment which will be charged on ___/___/___. The payments will be charged to the credit card listed below the day prior to the first BTW and final payment will be charged prior to the day of the second BTW. Name of cardholder ___________________________________
Signature
___________________________________
Date
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Credit Card Information Credit Card: Visa MC Credit Card Number: ________-_________-_________-_________ Exp Date: ____________ Security Code: ____________ Billing address is same as contract info? Yes No
If no, billing address: __________________________________________________