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 $590.00 plus 15% HST totaling $678.50 at the beginning of the program.
	Two equal payments of $339.25 within thirty days from start of program equaling $678.50
Special Payment Plans Please call to arrange special payments
	Three equal payments of $226.17 from start of the program
	Four equal payments of $170.00 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

School/University/Work

Learner's Master License No.

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

* required field