STUDENT AFFIDAVIT OF IDENTITY REQUIREMENT
Cheap Easy Fast Defensive Driving
Please fax completed form to 1-480-393-5281
We’re sorry, but your identity could not be verified using our third party databases. Texas rule 176.1110 (C)(7) requires that the
following form be completed and returned to our office before a certificate of completion may be issued on your behalf.
You are allowed to continue and complete the course but will not be issued a uniform certificate of completion until a completed
version of this form is received. Please print this form now.
Legal Name: ____________________________________________________________________________________
Mailing Address: _________________________________________________________________________________
City: __________________________________________________ State: ___________ Zip Code: ________________
Driver’s License Number (If Applicable): ______________________________ State Issuing License: ______________
Date of Birth (MANDATORY): __