Online Classroom + BTW Registration

Invoice ID
Online Classroom + BTW Registration

Don’t Walk, LLC DBA JUST DRIVE
200 W Summit Ave #280
Wales WI 53183
(262) 968-9009

Registration & Agreement
Student Information
Student Name*
First Middle Initial Last
Student Email*
Enter Email Confirm Email
Student Address*
Street Address Address Line 2 City State ZIP Code
Student Phone*
Date of Birth*
Date Format: MM slash DD slash YYYY
Billing (Parent or Guardian) Information
Name*
First Last
Email*
Enter Email Confirm Email
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Student User Information
Username
Password*
Enter Password Confirm Password
Driver's Ed Online Classroom + Behind The Wheel 6 Hours
Price: $495.00
Would you like to add 3 additional hours of Behind the Wheel to the program?
- + 3 hours of behind the wheel
3 Additional hours of Behind The Wheel
Price: $150.00
Total
$0.00
Leave Blank (Not a Coupon Field)
Terms and Conditions
JUST DRIVE will not refund any tuition or part of tuition if Just Drive is ready, willing, and able to fulfill its part of this agreement. No full or partial refund shall be given for the Online Course after the student reaches session 5 or after 15 days past the registration date (whichever comes first).

This written agreement constitutes the entire agreement between Just Drive and the student/parent/guardian. No verbal statements or promises will be recognized.

I also agree to pay a fee of $50.00 for each behind the wheel lesson or observation session not cancelled 24 hours in advance.
Do you agree to the terms and conditions?*
- I agree to the terms and conditions
Student E-Signature (Full Name)*
Date:
Date Format: MM slash DD slash YYYY
Parent or Guardian E-Signature (Full Name)*
Date:
Date Format: MM slash DD slash YYYY
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Name
This field is for validation purposes and should be left unchanged.

Online Classroom + BTW Registration

Online Classroom + BTW Registration

Student Information

Billing (Parent or Guardian) Information

Student User Information

Terms and Conditions