CSS Driver Training - Enrollment Form

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To enroll, fill out the following form and submit it to us. We will process it and your name will be on file. Please leave a contact phone number where we may contact you during the day. Reservations are not required for our regular programme.

Please select the course you wish to enrol in through the option listing.

You may use this form to pay with credit card.

Fill in your name, phone number and indicate the course you are enrolled in or want to pay for and fill in the credit card information at the end of the form.

*REQUIRED FIELDS

          Last Name *
         First Name *

     Street Address *
          Apartment 
               City 
        Postal code 
 Major intersection *

   Telephone (home) *
     (work or cell) 
             E-mail *

          Birth date (yy/mm/dd) 

                           Male 
                         Female 

        Driver's License Number *
                  License Class 
          Issue date (yy/mm/dd) 
         Expiry date (yy/mm/dd) 

                         Course *

 Comments

Note: The following section is for payment of course fees by credit card, and is not required to be filled out for enrollment. CSS Driver Training absolves all responsibility for the misuse of credit card information submitted with this form, due to the insecurity of the medium. Receipts will be given on request for fees paid to CSS. For information on appropriate fees, click here.

Visa M/C

        Payment type 
  Credit card number 
        Name on card 
 Expiry date (mm/yy) 
            Amount $ (usual course deposit: $350)

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