Blue Steel Auto School Student Form – Blue Steel Auto School

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Best Contact Number*

Evening Phone

Cell Phone

Email*

How Did You Hear About Us ?

Contact Okay

Yes

Call Okay

Yes

Do you have a 5 hr class? Only Answer If You Are Selecting A Package or 5 Hr Class. If not select N/A*

Marital Status

Gender

Date of Birth*

Special Needs

Permit Number*

Please Upload Your NYS Learners Permit*

Max. file size: 5 MB.

Select Package*

Quantity

Total

Hidden

Class