Page 5 - (Schedule Request Form)

A+ Missouri Driving Instruction 816-540-5930

Scheduling Request Form

Areas We Service*

Lee's Summit
Kansas City
Raymore
Harrisonville
Greenwood
Lone Jack
Pleasant Hill
Peculiar
Independence
Belton
Grandview
Raytown
Jackson County (See Specific Areas)
Cass County

Areas We Do Not Service*

North Kansas City
Blue Springs
Oak Grove
Odessa
Grain Valley
Platte County
Clay County

We DO NOT cover the following areas: North Kansas City, Blue Springs, Oak Grove, Odessa, Grain Valley.

We DO NOT do lessons in Platte or Clay County.

ATTENTION!

ONLY USE THIS FORM IF YOU:

1. Have already contacted us,

2. Know the rates in your area,

3. Are ready to schedule lessons,

4. And live in Jackson (Specific Areas) or Cass County.

DO NOT use this form unless you have already contacted us and know the rates in your area. If you do not know the rates in your area fill out PAGE 1 (Rate Request Form) on the Home Page.

SCHEDULING REQUEST FORM

Page5 Rate Request Form

EMAIL ADDRESS TO CONTACT YOU (Required Field)

Free Text

___________________________________________________________________

STUDENT'S NAME

Student's Address

City

WHAT COUNTY DOES THE STUDENT LIVE IN? (We DO NOT do lessons in Platte or Clay County. Check list above for cities that we service in Jackson County*)

JACKSON COUNTY*

CASS COUNTY

Zip Code

Student's Phone Number

Student's Age

If Student is 15 years old, when will they turn 16?

Does the student have a valid Missouri learner's permit that has not expired? (Yes or No)

If high school or college student, what school do you attend?

Free Text

___________________________________________________________________

Free Text

**PARENT OR GUARDIAN INFORMATION**

PARENT OR GUARDIAN'S NAME

CELL PHONE NUMBER OF PARENT OR GUARDIAN

Home Phone Number of Parent or Guardian

I would like to schedule:

Single 2-hour lesson

4-hours of lessons (2 lessons, 2 hours each)

The full 6-hour course includes certificate (3 lessons, 2 hours each)

I know the rates in my area

Yes

What rate were you quoted?

Questions/Comments

I UNDERSTAND AND ACCEPT THAT BY SUBMITTING THIS FORM IT DOES NOT GUARANTEE SCHEDULING FOR LESSONS. BECAUSE OF OUR BUSY SCHEDULE, OUR RESPONSE MAY TAKE UP TO 7 DAYS.

I Understand

About A+ Missouri Driving Instruction

A+ Missouri Driving Instruction is an insured business with over 30 years of experience teaching people throughout the Kansas City metro area to drive.

We can answer all your questions regarding any failed driving tests, and our training will cover all the skills that you need to be a competent driver.

Serving the Kansas City, Missouri Metro Area

Call Us Today

Resources

A+ Missouri Driving Instruction

Lee's Summit, MO 64063

816-540-5930

Missouri Driver Guide

Driver Exam Locations

Driver Licensing Checklist

Teen Drivers

Permit Practice Test

Driver Examination Division

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