Request New Certificate If you have not received your certificate of completion or you need another copy of your certificate, please use this form to request a new certificate. Thank You. "*" indicates required fields Student's Legal Name* First Middle Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Driver's License # Phone*Current Mailing Address* Street Address City State ZIP Driving School LocationPlease select the driving school where you took your course:BROWNSVILLE - Juarez Driving School (Gatti's Pizza)COPPERAS COVE - Arrive Alive of Texas Driving AcademyCORPUS CHRISTI - ABC Defensive DrivingEDINBURG - AVA Driving SchoolFLORESVILLE - Pizza Hut (539 W 10th St)HOUSTON - Cy Fair Driving SchoolKERRVILLE - Dieter CenterLAREDO - A&K World Class Driving SchoolLAREDO - Cardenas Driving SchoolMCALLEN - Cazares Driving SchoolNEW BRAUNFELS - Alamo Driving SchoolRAYMONDVILLE - Juarez Driving School (Gatti's Pizza)SAN ANTONIO - A Approved Defensive DrivingSAN ANTONIO - ADS Adult DrivingSAN ANTONIO - Ayala Driving SchoolSAN ANTONIO - Central Park Driving SchoolSAN ANTONIO - GTZ Driving SchoolSAN ANTONIO - JBAZ Office CenterSAN ANTONIO - Rhodes Driving School (114 N. Ellison Dr #103)TEMPLE - Bee County School of Defensive DrivingONLINEOTHERClass Date*When did you take the course? (If unknown, please estimate): MM slash DD slash YYYY Reason for AttendanceWhy did you take Defensive Driving on the above date? Ticket Dismissal Insurance Discount Education Court InformationPlease enter your court information as it appears on your citation or court issued documents: Reason for New Certificate*Please select the reason for your new certificate request: I have NOT received my certificate I received my certifcate, but it shows incorrect information I received my certifcate and it is correct, but I would like an additional copy Change(s)Please select what information requires a change (select all that apply): Name Address Date of Birth Driver's License Number Court Information Reason for Attendance Changes (Description)Please describe all necessary changes: Certificate Delivery*How would you like to receive your new certificate? Email (typically delivered within 2 business days) USPS First Class Mail (typically delivered in 7-10 business days) Email* Price Price: All new certificate requests made after 30 days from the original class date are subject to a processing fee. This fee also applies to all "additional copy" requests.Price Price: All "additional copy" requests are subject to a processing fee.Terms & Conditions* I agree.I understand that my certificate, relevant data, and payment will be processed by BetterDriverEducation.Com LLC according to the published terms and conditions and privacy policy found on BetterDriverEducation.com. No credit card information will be stored by BetterDriverEducation.Com LLC. I agree to pay a $10 processing fee for each "additional copy" of my certificate or if my new certificate request is more than 30 days after my original class date.Signature*Total Δ
