Access

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REFER - A - FRIEND

Please call the office to make  PAYMENT

 

WELLAND.....................905 650 8049

 

ST CATHARINES............905 650 8049

 

HAMILTON.................1 866 770 8079

NOTE:

2009  All Rights Reserved By Access Driving Education

                      TERMS & DISCLAIMER

FIRST NAME

LAST NAME

ADDRESS

CITY

STATE/PROVINCE

POSTAL CODE

HOME PHONE

CELL PHONE

EMAIL

LICENCE TYPE

LICENCE #

LOCATION

COURSE

COURSE START DATE

How did you hear about us ?

COMMENTS

TO REGISTER

Acceptable mode of   PAYMENT 

                 

Cheque Payable to:

"Access Driving Education"

 

Please MAIL the cheque

 

Mailing Address:

302 - 575 Lake St.

St. Catharines, ON L2N 4J1

                              

Cash / Debit Card / Credit Card

REGISTRATION FORM

FRIEND NAME *

FRIEND EMAIL *

FRIEND PHONE*

SERVICE REFERED *

YOUR NAME *

YOUR EMAIL *

COMMENTS

TO REFER A FRIEND

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