Online Drivers Improvement Course Registration (+5 Points) 

**PLEASE DOUBLE CHECK ALL INFORMATION TO ENSURE ACCURACY !!!!!!!!!!**
                                                        







Number looks like A00-00-0000


MM/DD/YYYY   or  MM-DD-YYYY
Address on License









Payment
Fee $75
No Refunds After 90 Days

YOU MUST CLICK THE PAYPAL LINK AFTER SUBMITTING THIS FORM TO PAY - ALL MAJOR CREDIT CARDS ARE ACCEPTED - PAYPAL ACCOUNT IS NOT REQUIRED
**PLEASE DOUBLE CHECK ALL INFORMATION TO ENSURE ACCURACY !!!!!!!!!!**