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Title   Mr Miss Mrs Ms

First Name

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Address

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Business Telephone Number

Lesson Prices (optional)

Website URL (optional)

Facebook URL (optional)

Would you like your driving school to feature on a “Find a Driving Instructor”   No Yes

Are you a member of a National Association?   No ADIFED ADINJC DIA DIDU DISC MSA GB

Enter group name

None FBTC MyDriveTime PassMeFast WeDrive.Fun Driving School Development

I would like any commission I am due to be paid to go to After Umbrage and Riding for the Disabled.   No Yes

Please provide the following information so that we may pay your commission directly into your account. No money can be taken from your account.

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Bank Name

Sort Code Account Number

  AA BSM Chilled Barry Grainger Insurance Simply Insurance Other

Would you like to receive marketing emails.   No Yes

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