CLASS E COURSE APPLICATION FORM:

Our Class E Course includes one day of in-class to study Defensive Driving theory. The Defensive Driving class dates are listed below. Please select the class date you want to attend and complete all fields on this form.  Incomplete application forms cannot be processed. When you apply for one of our courses on-line, payment must accompany your application. Please provide your credit card information below. Application forms without payment cannot be processed. You must be 21 or over to apply for this course.

Class E Course Cost $580.00 (CDN Funds) 
Course tuition is tax exempt
Course Start Date:
First Name
Last Name
Your Phone Number: (include area code)
Address:
City:
Province: , Canada
Postal Code:
Your Age:
Driver's Licence #:
Class of Current Licence:
Date you did the Written Beginners Test:
(We cannot book you a road test without this information)

Payment Information:
Method of Payment:
Name as appears on card:
Card Number:
Expiry Date: (M/Y)
Payment Amount 
to be appplied to card:
Signature: (Enter your email address here) 

When you enter your email address in the "Signature" field on this form, it will act as your electronic signature for this application.

You can also use this form to register by mail. Print it, fill it in and send to our Head Office at: 
427 Exeter Rd., London  ON  N6E 2Z3 along with your payment.
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Submitting this form does not guarantee entry to this course.
Confirmation of enrolment will be sent to you by email once your application has been processed by the office.

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