Driving School Receipt

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Please fill out, sign, and return this completed form along with the following documentation needed to process a permit: 9 9 9 9 9 Check made payable to Windsor-Brunswick Driving Academy, LLC for _______________ Check made payable to NJ MVC in the amount of 10.00 (permit fee) The Motor Vehicle Commission Card signed by BOTH student and parent The student’s Secondary School Driver Examination Card with test score (if applicable) Original form of acceptable Identification o Civil Birth Certificate (must have raised seal) hospital birth certificates are not accepted o Valid US Passport o Current or Updated Resident Alien Card (green card) o Citizenship papers PHOTOCOPIES ARE NOT ACCEPTED MUST PROVIDE ORIGINAL FORM OF IDENTIFICATION Remember…Cancellations Require 24 Hour Advance Notification Receipt Amount Paid: ___________ Payment Method: (circle one) Signature: ___________________________________________ Windsor – Brunswick Driving Academy Check _______ Date: ___________ Credit / Debit Cash Dates of Instruction: __________________ Returned Checks Subject To a 50 Returned Check Fee Page 1 of 2 LICENSE NUMBER: _____________ http://www.wbdriving.com email: WBdrivingacademy gmail.com 141 New Road Œ Monmouth Jct., NJ 08852 732-821-4911 y 609-448-5014 Service Agreement This agreement between Windsor-Brunswick Driving Academy, LLC and __________________________ will include the following services: ITEMIZED ACCOUNT SERVICES Cost to Student Instructional Service 6 Hour Behind-the-Wheel 350 Permit Purchase Agency 2 Hour Refresher Course Knowledge Test (written) Road Test Service - Review Lesson Included - Use of Car Included - Buy License Included 10 120 50 150 (includes 1 hour buy license service ) - Transportation to Vision Test Included Additional fee of 20/hour if wait time inside license center exceeds 1 hour (Receipt will be provided by Instructor) Instruction Services Lessons Mins Per Lesson Behind the Wheel 120 3 Cost Per Lesson Total Cost of Lessons Classroom Refresh

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