I (your legal name)

As shown on credit card

First Name

Last Name

Florida driver's license number

certify that I am fully authorized to charge the credit/debit card or account ending with

Please enter just the last 4 digits

under company name

Please enter the legal name

registered in Sunbiz.org under document #

to pay the driving services for

Name of Student

First Name

Last Name

If any question, please email me at

Please enter the same email you entered when you paid online

We appreciate your interest and we acknowledge receipt of your application. In the event that we wish to arrange a personal interview, we will contact you by mail or phone. Again, thank you for your interest in employment at JMP Driving School

Card or Account Certification