De 964 Form PDF Details

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Form NameDe 964 Form
Form Length1 pages
Fillable fields18
Avg. time to fill out3 min 51 sec
Other namesde 964, de 964 form printable, de 964 form no download needed, get the de 964 form

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- TDLR Parent Taught Course Provider DE-964

PT Course Provider Number:



Number of certs ordered: ______________________________

Prepared by:



Certificate numbers: __________________________________ to ___________________________________

Pick-Up or E-mail date/time:









DE-964 – TDLR Parent Taught Driver Education Certificate Order Form

(For Use by Parent Taught Course Providers Only)



Parent Taught Course Name: _____________________________________________________ CP#


_________ X

$1.00 each







Original Signature of Parent Taught Course Owner


Printed Name




Check one box and enter the applicable address:

HARD COPIES (3-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 PT course provider)

*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:




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 office. No exceptions.


DE-964 (03/2016)

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