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:

 

 

 

 

 

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):

 

 

 

 

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: