1. Personal information - for booking purposes only
Title
Mr.
Mrs.
Miss
Ms.
Name (in full, please)
* required
Address line 1
Address line 2
Town
County
Postcode
Country:
Telephone No. (home):
* required
Telephone No. (work):
Telephone No: (mobile):
Fax No.:
E-mail Address:
* required
Date of Birth:
Driving Licence Number:
2. Options
I would like to start my course on:
Course Required:
Course A (5 Days - 20 hours) £550.00
Course B (7-10 Days - 26 hours) £699.00
Course C (8-10 Days - 32 hours) £799.00
Course D (2-3 Weeks - 38 hours) £899.00
Course E (2 Weekends - 18 hours) £550.00
Course F (Short Course - 10 hours) £299.00
I will send a deposit of £150.00 (the balance is payable two weeks prior to the beginning of your course)
I will send the theory test fee/voucher
I have passed my theory test
Theory Pass Certificate Number:
Date Theory Test Was Passed:
I would like tuition in an automatic car
3. Payment
I will be paying by Visa/Mastercard through your secure server (deposit or full amount)
I will be paying by cheque/postal order (cheques or Postal Orders should be made payable to Intensive Driving Tuition)
I would like to pay by Visa/Mastercard but will fax my account number, expiry date, name and address of card holder to: +44 (0)1638 710928
Please acknowledge this booking by:
E-mail
Fax
Phone
Post
