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Behind-the-Wheel Instruction Order Form
Region 6 Education Service Center
c/o Safety Education
3332 Montgomery Rd. – Huntsville, Texas 77340-6499
Date:
Parent’s Name:
Student’s FULL Legal Name:
USPS Mailing Address:
City:
State:
Day Phone:
(
)
-
Zip Code:
E-mail:
***Please print legibly and ALL boxes must be filled out completely, thank you! ***
Behind-the-Wheel Instruction Only!! Training Packet Includes:
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•
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Texas Traffic Safety Education In-Car Manual
Study, Review, & Chapter Quizzes
Lesson Plans for 7-Hours Behind-the-Wheel Instruction and
Plans for 7-Hours of Supervised Instruction
DE-964E Texas Driver Education Certificate of Completion for
Behind-the-Wheel Instruction
(must have completed the 32 hours of classroom instruction)
For mail-in orders, we only
accept Cashier’s Checks
and Money Orders payable
to:
$43.50 + tax and shipping
Total Price Per Packet:
__$50.03__
Circle One:
“ESC6”
(NO PERSONAL CHECKS) PSSST! Save time and order online with a credit
Cashier’s Check or Money Order # ___________________________
Phone: (936) 435-8343
card in our online shopping cart at:
http://safetystore.esc6.net
Ready SET Drive Comprehensive Student Training Packet
 TEA and DPS Approved!
 Texas Specific!
 Region 6 Education Service
Center has over 40 years of
Traffic Safety Experience!
Office Use Only: Date Received: _______________________
DE-964E # Issued: ______________________