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Student's First Name:

Student's Middle Name:

Student's Last Name:

Home Address:

Mailing Address: (If Different)

City:

, CA

Zip Code:

Major Cross Street:

Age:

Date Of Birth:

Home Phone Number:

Student's Cell Number:

Parent's Cell Number:

Parent's Names:

and

Driver Ed Completed At:

Driver Ed Certificate Number: (Near the Bar Code - Leave Blank If None)

High School:

E-mail address:

Select The Type Of Education You Need From The Choices Below:

DRIVER EDUCATION & DRIVER TRAINING PACKAGES:

THE BASIC PACKAGE: (Minimum Legal Requirement)
Driver Ed (25 Hours Classroom) & Driver Training (6 Hours Behind-The-Wheel)
Full Payment - $415 (You Save $35) or
or Payment Plan - $450 (3 Payments: $150, $150, $150)

THE ADVANCED PACKAGE:
Driver Ed (25 Hours Classroom) & Driver Training (8 Hours Behind-The-Wheel)
Full Payment - $510 (You Save $15) or
Payment Plan - $525 (3 Payments: $175, $175, $175)

THE RECOMMENDED PACKAGE:
(Recommended By The National Transportation & Safety Board)
Driver Ed (25 Hours Classroom) & Driver Training (10 Hours Behind-The-Wheel)
Full Payment - $590 (You Save $15) or
Payment Plan - $605 (3 Payments: $205, $200, $200)

THE DELUXE PACKAGE:
Driver Ed (25 Hours Classroom) & Driver Training (12 Hours Behind-The-Wheel)
Full Payment - $675 (You Save $20) or
Payment Plan - $695 (3 Payments: $245, $225, $225)

THE ULTIMATE PACKAGE:
Driver Ed (25 Hours Classroom) & Driver Training (20 Hours Behind-The-Wheel)
Full Payment - $995 (You Save $25) or
Payment Plan - $1020 (3 Payments: $340, $340, $340)

**SIGN UP FOR THE ULTIMATE PACKAGE, AND GET YOUR DRIVER EDUCATION FOR FREE!**

DRIVER EDUCATION ONLY: ONLINE COURSE

ONLINE www.ezwaydrivingschool.com/online
Full Payment - $100

DRIVER TRAINING ONLY: BEHIND THE WHEEL

BASIC: 6 Hours Behind The Wheel
Full Payment - $330 (You save $35) or
Payment Plan - $365 (3 Payments: $130, $130, $105)

ADVANCED: 8 Hours Behind The Wheel
Full Payment - $420 (You Save $15) or
Payment Plan - $435 (3 Payments: $145, $145, $145)

RECOMMENDED: 10 Hours Behind The Wheel
Full Payment - $515 (You Save $15) or
Payment Plan - $530 (3 Payments: $200, $200, $130)

DELUXE: 12 Hours Behind The Wheel
Full Payment - $600 (You Save $15) or
Payment Plan - $615 (3 Payments: $205, $205, $205)

ULTIMATE: 20 Hours Behind The Wheel
Full Payment - $995 (You Save $25) or
Payment Plan - $1020 (3 Payments: $340, $340, $340)

**SIGN UP FOR THE ULTIMATE PACKAGE, AND GET YOUR DRIVER EDUCATION FOR FREE!**

*If you will be attending our classroom course, Driver Ed must be completed within 4 consecutive class dates*

Please choose your classroom start date:
2009/2010

Nervous/Fearful/Learning Disability/Handicap/Different Language or Other Special Needs?
If So, Please Explain Fully Below:

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WE WILL CALL YOU SHORTLY TO CONFIRM THAT WE RECEIVED YOUR ENROLLMENT.

Send mail to EZWAYDRIVINGSCHOOL@MSN.com with questions or comments about this web site. Copyright © 2007 E-Z Way Driving School Last modified: May 26, 2010

Send mail to EZWAYDRIVINGSCHOOL@MSN.com with questions or comments about this web site.
Copyright © 2007 E-Z Way Driving School
Last modified: May 26, 2010