TrafficSchool.com Fleet Safety Registration Form

Online Fleet Course Registration Information

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Thank you for selecting TrafficSchool.com's Online Traffic Safety Course™ to fulfill your traffic school needs. Upon completing our registration information pages, you will be granted access to our course and may begin TrafficSchool.com immediately. In order to ensure that your certificate is processed without delay, please fill in all required fields with accurate and complete information. Single course price is $34.95. Enter company promotion code for a discount.

Enter Your Contact Info

First Name*:

Middle:

Last Name*:

Street Address*:

Apt/Suite #:

City*:

State*:

Zip*:

Daytime Phone*:

Include area code & any applicable extension.

Evening Phone:

Email Address*:

Enter complete email address (ex: yourname@aol.com).

Confirm Email*:

Retype complete email address exactly.

Enter Other Information

Company Name:

Employee No. or Code*:

If not applicable, enter "None".

License State*:

Driver License #*:

Gender*:

Male Female

Birth Date*:

/ /

Referred By*:

How did you hear about us?

Promotion Code:

If you have a promotion code, enter it here to receive your discount.

I am interested in getting discounts for TrafficSchool.com products, useful information, and other special offers and contests designed to drive down my costs of driving.

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