To :
Kingston Driving School,
7 Heathfield Way,
Barham,
Canterbury,
Kent,
CT4 6QH
APPLICATION FOR A LEARNER'S DRIVING COURSE
(Please use BLOCK CAPITALS)
|
Mr/Mrs/Miss/Ms: |
|
Surname: |
Forename: |
Address:
|
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| Post code: |
| Telephone Home: | Work: |
| DRIVER NUMBER (as shown on License): |
| THEORY TEST No. (as given on certificate): |
I am paying £100 by credit card. The balance is to be paid by cheque/postal order/credit card, two weeks before your course commences.
Credit Card Details:
| Address: (Card billing address):
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| Card Number: |
| Issue Number (Switch Cards only): |
| Expire Date mm/yyyy: |
COURSE SELECTED (Refer to Course Fees & then select either Option 1 or 2)
Option(4 hrs)…..7 day [....] 5 day [.…] 3 day [….]
Option(5hrs)…..7 day [….] 5 day […. ] 3 day [….] 2 day[....]
Type of car Manual [….] Automatic[….]
INDICATION OF DRIVING EXPERIENCE TO DATE
None [….] Beginner 1 - 10 Lessons [….] Intermediate (more than 10 Lessons) [….]
| Disabilities (if any): |
Have you taken the Test and failed? Yes [ ] No [ ]
| If so, how many times?: |
COURSE DATE
| 1st Choice: |
| 2nd Choice: |
| 3rd Choice: |
Accommodation yes [….] No [….]
I am aware that I must reach the necessary standard in order to take my driving test
Date:
Signature: