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Secure Application
Step 1:
General Information
Name
*
Date of Birth
*
Month
January
February
March
April
May
June
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December
Day
1
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Year
2007
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1914
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1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Gender
*
Male
Female
Are you a citizen of the United States?
*
Yes
No
Height and Weight
*
Height (Feet)
4’
5’
6’
7’
Height (Inches)
0”
1”
2”
3”
4”
5”
6”
7”
8”
9”
10”
11”
Hair and Eye Color
*
Address where you live (a mailing only address cannot be used)
*
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Phone
*
Email
*
Marital Status
*
Marital Status
Single
Married
Widowed
Separated
Divorced
Employment Status
*
Employment Status
Employed
Unemployed
Self-employed
Insurance Status
*
Health Insurance
Private Insurance
Public Insurance
Uninsured
Auto Insurance
Liability Coverage
Collision Coverage
Comprehensive Coverage
Medical Payments Coverage
Personal Injury Protection
Uninsured and Underinsured Motorist Protection
Vehicle
Step 2:
Driving History
Have you ever had a Driver License?
*
Yes
No
If yes, write from what country, state, or jurisdiction?
Has your license ever been suspended or revoked?
*
Yes
No
Has your application for a Driver License been denied in another country or state?
*
Yes
No
Step 3:
Medical History
Do you require corrective lenses or glasses for the vision screening test?
*
Yes
No
Are you required to wear a hearing device while driving?
*
Yes
No
In the past 5 years, have you had or been treated for any of the following? If yes, to an item, please complete the Medical/Eye form.
Alzheimer's Disease
*
Yes
No
Insulin Dependent Diabetes
*
Yes
No
Glaucoma, Cataracts, or Eye Diseases
*
Yes
No
Seizure or Loss of Consciousness
*
Yes
No
Do you have other mental or physical conditions that would impair your ability to drive?
*
Yes
No
Step 4:
Preferences
All males 18-26 years old will be registered with
Selective Service
.
To opt out, complete the opt-out form.
I would like to add a
Veteran designation
to my license card.
If yes, provide proof of your status.
*
Yes
No
I would like to be an
organ and tissue donor
.
*
Yes
No
What language should we use to communicate with you?
*
Special Designations:
Add to my Driver License.
Autism
*
Yes
No
Visually Impaired
*
Yes
No
Intellectual Disability
*
Yes
No
Hearing Impaired
*
Yes
No
Step {( currentStep )}:
Payment Information
Billing Name
*
Billing Address
*
The billing address and ZIP must match your credit card.
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Billing Contacts
*
Credit Card
*
CARDHOLDER NAME
CARD NUMBER
EXPIRY MONTH
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01
02
03
04
05
06
07
08
09
10
11
12
EXPIRY YEAR
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2031
2032
2033
2034
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2036
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2040
2041
2042
2043
2044
SECURITY CODE
Drivers License Application Guide and Pre-Filling Total:
$34.95
Discount Shopping Club Membership Total:
$
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. You agree to submit the information provided for the use of generating your pre-filled application. You also certify that you are 18 years of age or older. You will be charged immediately and will receive (via download) the step-by-step guide and pre-filled application for the process you have chosen. WaDLP.org is not owned by, affiliated with, or operated by the State Department of Driver Services or any government agency, and therefore cannot complete any State DMV processes for you. You understand, that State DMV provides forms and instructions for filings related documents at no charge. We charge for the time and convenience of accumulating all of these services into one simple solution.
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