De 964 Form PDF Details

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Form NameDe 964 Form
Form Length1 pages
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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- 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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writing de964 form step 1

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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