De 964 Form PDF Details

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QuestionAnswer
Form NameDe 964 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameswhat does a de 964 form look like, de 964, de964, de 964 form texas

Form Preview Example

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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Fill out the HARD COPIES part paper completion, Delivery Address, WALKIN or PICKUP service from, Overnight Delivery of hard copies, NUMBERS Identifying numbers for, A certificate proof must be, will be sold, Email Address, MAILIN ORDERS, Certificates X each, Total enclosed, and Make check or money order payable area with the information demanded by the program.

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