On-Line App. ~ High School Driving Academy Ltd.

Application Form

Please fill-out the following High School Driving Academy Ltd. application form.

Preferred Payment Plans Please select one
	Full payment of $620.00 plus 15% HST $93.00 totaling $713.00 at the beginning of the program.
	Two equal payments of $356.50 within thirty days from start of program equaling $713.00
Special Payment Plans Please call to arrange special payments
	Three equal payments of $237.67 from start of the program
	Four equal payments of $178.25 from start of the program

Program Date
Select Month Wanted	*

Student Information

Last Name

First Name

E-Mail

Mailing Address

City

Postal Code

Home Telephone

Student Cell Phone

Are you currently a student?

Yes No

If yes, at what school?

Learner's Master License No.

Enter the security code from the image into the blank box:

* required field