TDLR ADE-1317 (Rev.03/2016)
FOR TDLR STAFF USE ONLY - TDLR Licensed Driver Education School - ADE-1317 hard copies or ADEE-1317 certificate numbers
DE School Number: Number of certs ordered:
Prepared by: Certificate numbers: _________________________________ to __________________________________________
Pick-Up or E-mail date/time:
ADE-1317 - Adult Driver Education Certificate Order Form
ALL FEES ARE NON-REFUNDABLE
ALL UN-USED CERTIFICATES, NUMBER ORDERS ARE NON-TRANSFERABLE
Driver Education School Name: C
Certificates: __________ x $1.00 each
Original Signature of School Owner or Director Printed Name Date
Check one box and enter the applicable address:
HARD COPIES (2-part paper completion certificates ready to issue)
Delivery Address:
Overnight Delivery of hard copies is not available. Out-of-state shipments are not available.
WALK-IN or PICK-UP service from 920 Colorado St, Austin, Texas 78701 will require 72 hours to process.
Call (512) 463-6599 for details.
NUMBERS* (Identifying numbers for completion certificates printed and issued by the above school owner)
* A certificate proof must be submitted and approved by the Texas Department of Licensing and Regulation before certificate numbers
will be sold.
E-mail Address:
MAIL-IN ORDERS
Certificates: _________ X $1.00 each Total enclosed $ ______________
Make check or money order payable to TDLR. Cash is NOT accepted. Mail payment and this original completed and
signed order form to:
Texas Department of Licensing and Regulation
P O BOX 12157
Austin, Texas 78711
Orders will be processed only when fees and this signed order form have been received by TDLR. No exceptions.
click to sign
signature
click to edit