Form Ade 1317 – Fill Out and Use This PDF

FOR TDLR STAFF USE ONLY -				TDLR Licensed Driver Education School - ADE-1317 hard copies or ADEE-1317 certificate numbers					Receipt #: _______________________
DE School Number:					Number of certs ordered:				Fee paid:
Prepared by:					Certificate numbers: _________________________________				Date paid:
Pick-Up or E-mail date/time:					to				Initialed:

ADE-1317 - Adult Driver Education Certificate Order Form

Driver Education School Name:				C
	Certificates: __________ x $1.00 each
Original Signature of School Owner or Director			Printed Name		Date

Check one box and enter the applicable address:

HARD COPIES (2-part paper completion certificates ready to issue)

Delivery Address:

Overnight Delivery of hard copies is not available. Out-of-state shipments are not available.

WALK-IN or PICK-UP service from 920 Colorado St, Austin, Texas 78701 will require 72 hours to process. Call (512) 463-6599 for details.

NUMBERS* (Identifying numbers for completion certificates printed and issued by the above school owner)

*A certificate proof must be submitted and approved by the Texas Department of Licensing and Regulation before certificate numbers will be sold.

E-mail Address:

MAIL-IN ORDERS

Certificates: _________ X $1.00 each

Total enclosed

$ ______________

Make check or money order payable to TDLR. Cash is NOT accepted. Mail payment and this original completed and signed order form to:

Texas Department of Licensing and Regulation

P O BOX 12157

Austin, Texas 78711

Orders will be processed only when fees and this signed order form have been received by TDLR. No exceptions.

TDLR	ADE-1317 (Rev.10/2/15)