De 964 Form PDF Details

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QuestionAnswer
Form NameDe 964 Form
Form Length1 pages
Fillable?Yes
Fillable fields22
Avg. time to fill out4 min 43 sec
Other namesde 964, de 964 form printable, de 964 form pdf, imgurl

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FOR TDLR STAFF USE ONLY

- 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)

ALL FEES ARE NON-REFUNDABLE

ALL UN-USED CERTIFICATES, NUMBER ORDERS ARE NON-TRANSFERABLE

Parent Taught Course Name: _____________________________________________________ CP#

Certificates:

_________ X

$1.00 each

 

 

 

 

 

 

Original Signature of Parent Taught Course Owner

 

Printed Name

 

 

Date

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:

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 office. No exceptions.

TDLR

DE-964 (03/2016)

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Write down the details in the Delivery Address:, Overnight Delivery of hard copies, WALK-IN or PICK-UP service from, NUMBERS* (Identifying numbers for, * A certificate proof must be, E-mail Address:, and CREDIT CARD ORDERS area.

Filling in de964 form stage 2

In the MAIL-IN ORDERS Certificates:, Total enclosed, Texas Education Agency – DTS, Austin, Orders will be processed only when, ESC 13, and DE-964 (Rev part, emphasize the crucial details.

de964 form MAIL-IN ORDERS Certificates:, Total enclosed, Texas Education Agency – DTS, Austin, Orders will be processed only when, ESC 13, and DE-964 (Rev blanks to insert

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