Online Drivers Improvement Course Registration (+5 Points) 

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

                                                        

Reason for Class

Voluntary (To Receive 5 good points OR preparation for upcoming court date) DMV Required (DMV Issued letter ordering this class) Court Ordered (A Judge ordered you to take this class - not a lawyer)

Type of License 

Regular License Learners Permit

Full Legal Name

First Name

Middle Name

Last Name

Customer ID Number (Drivers License Number) 

Number looks like A00-00-0000

Gender 

MaleFemale

Date of Birth 

MM/DD/YYYY   or  MM-DD-YYYY

Address on License

Street Address 

City

State

Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau

Zip Code

Cell Phone

Home Phone

Email

Confirm Email

Comments

Payment

Fee $75

No Refunds After 90 Days

 Option of Payment

Please select... Credit/Debit CardYOU 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 !!!!!!!!!!**

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