Adult Individualized Hourly Lessons

Adult Individualized Hourly Lessons

Fill out the form carefully for registration
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Instruction Permit Number*
Issued Date*

MonthDayYear
Date
Expiration Date*

MonthDayYear
Date
State*

Street Address

Street Address Line 2

CityState

Zip Code
Student Address*

Street Address

Street Address Line 2

CityState

Zip Code
Student E-mail*
example@example.com
Student Phone Number*
Format: (000) 000-0000.

Please Select which session you would like to register.*

$105.00 Select a session from the dropdown list
Item subtotal:$0.00

DMV Drive with our vehicle (Optional)

All customers seeking local DMV test vehicle will be provided with our vehicle for DMV test. Fee rate - 2 hours reservation at DMV for $190.00

$ Free Would you like to use our vehicle for DMV Drive test? (Optional)

Total

$0.00

Please note that once you have booked an appointment with us it means that we have reserved time in our schedule exclusively for you. If you cancel your appointment less than [24 hours] before it is scheduled to take place, you will be subject to a [penalty/fee/rebooking charge of $50]. To avoid a cancellation fee, please provide cancellation notice at least [24 hours] prior to your appointment. You can cancel or reschedule an appointment by emailing us at [info@horizondrivereductionllc.com], texting or calling our office at [503-680-6544].
Signature*
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