Adult BTW Only       ExhibiL-2

ADULT IN-CAR STUDENT ENROLLMENT CONTRACT

Please read the form and fill your information in blank and make sure you sign and date both contract and record forms.

*Student's Full Legal Name: Date of Birth:

*Student's Address:Home Phone:

*City, State, Zip: Work Phone:

*Mailing or office address:Cell Phone:

*TX License Number:   SSN:

*E-mail:

*Responsible party Full Name & address (company or other than student)

*Referred By [Friend Name, Internet, Advertising]

BEHIND-THE WHEEL INSTRUCTION            (office use only)

Number of lessons_______ Length of  Lesson _____Hrs. Cost per Lesson$______ Course Rate $________

First payment      $__________Date ___________________                Road Test $____________________

Second payment $__________Date ___________________ Total Amount of Contract $_______________

Paid in full           $__________Date ________________ **Administrative Expense (up to $50)_________

Instruction begins ____/____/____ at ____o'clock, _____M Balance Due           $____________________

 

CANCELLATION POLICY

A full refund will be made to any student who cancels the enrollment contract before midnight of the third day, excluding Saturdays, Sundays, and legal holidays, after the enrollment contract is signed by the prospective student, unless the student has completed the course and accepted a certificate of completion during that period.

Student must give cancellation call 10 hours before appointment time to avoid $25 charge.

There will be $40 service charge for Return Check

 

REFUND POLICY

1.  Payments are made at the time of service or prepay.

2.  Refund computations will be based on deposit and actual instruction received through the last date of

     Attendance.

3.  Refunds shall be completed within 30 days after the effective date of termination.

STUDENT ACKNOWLEDGMENT

1. This agreement constitutes the entire contract between the school and the student and no verbal assurance

   Or promises not contained herein shall bind the school or the student.

2. This driver education school maintains business vehicle insurance as required by the Transportation

    Code, Chapter 601, and uninsured or underinsured coverage.

3. Any grievances not resolved by the school may be forwarded to: Texas Education Agency, 1701 North

    Congress Avenue, Austin, Texas, 78701.  (512) 936-6777.

4. I have been furnished a copy of the school tuition schedule and cancellation and refund policy.

 

(Signature of Student)

                             (Date)

_______________________________   ____________________________   ____________________________

(Signature of School Representative) (Print name of representative)                                                      (Date)

 

Texas Education Agency                                        Page1 of 2                                                DE-005-2  (Rev 6/1/ 2006)