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SIM'S
 makes
 "Parallel Park" simple.


Next Driver's Ed. Class:

June 4, 2018
5:00PM-8:30PM

Enrollment Form

Yes
! I would like to enroll with SIM'S Driving School for service(s) marked below;
(Fields marked with an (asterisk) * are required)

First Name: * Last Name: *
License /Permit Number: *
Date of Issue: (mm/dd/yy) *
Date of Expiration: (mm/dd/yy) *
Date of Birth:   ,  (Month-day-year) *
Social Security Number: --* (xxx-xx-xxx)
Address: *
City: *
State: * Zip code: *
Telephone: *
Email:
Parent/ Guardian Name: (if you are less than age 18)
   
SERVICES: Please choose the one you are enrolling for:
  Other (Please describe):
METHOD OF PAYMENT:
Card Holder Name:
Account Number: CCV:
Card Expires: / (mm/yy)
 
REFUNDABLE AND PAYABLE POLICY:
At the enrollment as an account is paid in full. And if a customer fails to receive the service or withdraw prior to the service commence, the refund policy is as the following:
A. If the service is discontinued or the enrollment is not accepted, all money paid will be refunded.
B. Upon receiving a written notice of cancellation within 5 business days prior to the beginning of service, all money paid will be refunded.
C. When the refund is given the enrolled services being automatically cancelled with all related obligations.
D.
Refund is not given with an Alt/Off-hour road test sponsor and if a student fails to receive the service due to excessive absences or violate the written policy of the enrolled service.
STUDENT OBLIGATIONS:
A. Have to have an intention and to be prepared to learn and do road test.
B.  Keep up schedule and attend the class regularly, call in advance if in the event of unavoidable absence.

c. Agree to accept the written privacy policy of the service(s) enrolled for.
D.
While driving; pay full attention to the task, no receiving or making a phone call.

I have read, understand and agree to the TERMS and CONDITIONS written in this Enrollment Form.
 
Rev.12/31/07SIMS DS.
1-877-558-SIMS / (978)-459-7467 Boreth@SimsDrivingSchool.com  www.simsdrivingschool.com

60 Middlesex Street (Route 110) Lowell, MA 01852

SIMS DS. ENROLLMENT FORM





SIM'S Driving School is a Licensed Professional Driving School. We are insured by the COMMERCE INSURANCE COMPANY for the vehicles, THE HARTFORD for liability and the NGM Insurance Company for the Surety Bond. Copyright @ SIM'S Driving School. All rights reserved.

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