Payments are not taken through this form.
Personal Information
Full Name
Full Address with postcode for licence
Full Address with postcode to be picked up from for lessons
Date of Birth (dd/mm/yyyy)
Mobile Number
Email Address
Provisional License
Have you got a Provisional License?
Provisional License Number (On line 5 of your licence card)
If No, Have you sent off for a Provisional License
If Yes, Please confirm date posted
If No, When are you likely to complete the form for your Provisional License
Driving Experience
Have you driven before?
If Yes, How many hours experience
Which type of Vehicle (Auto/Manual)
General Information
Is there a date you need to pass by:
What date would you like to start on:
What times would require for intensive course?
Do you require any special requirements (eg ADHD,Dyslexia,Dyspraxia or anything else)
Manual / Automatic Intensive Course
Which intensive course did you wish to be considered for:
Visit our price page for more explanation on the intensive course including week day practical driving test.
Do you require us to book a Theory Test?
Theory
Have you passed your Theory Test
If Yes, When did you pass your Theory Test (date)
If Yes, when does this run out (date)
If Yes, Please provide Theory Test Certificate Number
If No, when is your theory booked confirm date / time / place:
Date Time: Place
Do you require us to book a Theory Test
Would you like week day or Saturday booking for theory test
Which centre would you like to take your theory test at
Practical Driving Test
Have you got a driving test booked
If Yes, can you confirm date / time / place
Date: Time: Place
If No, please confirm your 1st,2nd,3rd choice where you would like to take your practical driving test (Test Centre)
Have you got to have an extended practical driving test?
If Yes, what was the reason for behind this? (Additional costs will apply)
Do you require a Saturday or Bank Holiday practical driving test
If Yes additional cost will apply
Have you ever taken a test before?
If Yes, How many have you taken?
When did you fail?
What was the reason why you failed?
Additional Information
Is there any other information to help us choose the right intensive driving course for you and your needs?
