DE-964 – TDLR Parent Taught Driver Education Certificate ...
DE-964 PARENT TAUGHT DRIVER EDUCATION CERTIFICATE ORDER FORM
PT Course Provider License Number:
FOR TDLR STAFF USE ONLY Number of certificates ordered:
Prepared by:
Certificate numbers:
to
Shipping or email date/time:
Name of Parent Taught Provider:
PT Provider License Number: PT
Certificate Format: (Check one box and enter the required information)
HARD COPIES (3-part paper completion certificates ready to issue)
Number of Certificates: __________ x $1.00 each
Delivery Address:
Number, Street Name, Suite Number/Building Number
City, State, Zip Code
P.O. Box or Out-of-state shipments are not available. Orders will be delivered using a parcel delivery company. Someone must be at the location listed on the order form at the time of delivery to sign for the certificates.
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.
Number of Certificates: __________ x $1.00 each
Email Address:
Please Note: Orders will be processed only when fees and this signed order form have been received by TDLR office. All unused certificates, and/or number orders are non-transferable
Total enclosed (Fees Are Non-Refundable): $ ______________
SEND YOUR COMPLETED ORDER FORM AND REQUIRED FEE TO:
Texas Department of Licensing and Regulation P.O. Box 12157 Austin, TX 78711-2157
Keep a copy of your completed order form, and your check or money order. Do not send cash.
For additional information and questions, please visit the Texas Department of Licensing & Regulation website or reach the Education and Examination division via webform where you can submit your request for assistance and include attachments as needed.
Original Signature of School Owner or Director TDLR Form DES145N rev January 2023
Printed Name
Date
................
................
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