Complete this form to pay the Behind the Wheel portion. This is a one-time fee that covers the 3 BTW lessons. Student's Full Legal Name* First Middle Last Email* Enter Email Confirm Email BTW Fee* Full Payment $194.00 Payment Plan- 1st payment $109.50 Payment Plan - 2nd payment $109.50 Total $0.00 Credit Card* DiscoverMasterCardVisaSupported Credit Cards: Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 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. Δ
