Traditional Failure to Yield Registration

Invoice ID
Traditional Failure to Yield 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
Drivers License #*
Please use all capital letters, no spaces and no dashes
Billing Information
Name*
First Last
Email*
Enter Email Confirm Email
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Traditional Failure to Yield
Price: $115.00
Leave Blank (Not a Coupon Field)
Total
$0.00
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.

This written agreement constitutes the entire agreement between Just Drive and the student/parent/guardian. No verbal statements or promises will be recognized.
Do you agree to the terms and conditions?*
- I agree to the terms and conditions
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.

Student Information