Complete this form to pay the gas surcharge. This is a one-time fee that covers the fuel for all lessons. Student's Full Legal Name* First Middle Last Email* Enter Email Confirm Email Gas Surcharge* Price: $25.00 Total $0.00 Credit Card* DiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Parent Signature - I agree to requirements listed below:* First Last REFUND POLICY: All sales are final. There are no refunds.
