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Step 1:
Form Information
Do you now have or have you ever had a Georgia Driver's License, Identification Card or Permit?
*
Yes
No
Georgia Driver's License/ID/Permit Number
*
Name
*
Suffix
Jr.
Sr.
II
III
IV
Mailing Address
*
State
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Alaska
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Residential Address
*
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
Phone
*
Email
*
Gender
*
Male
Female
Date of Birth
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
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1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Height and Weight
*
Height (Feet)
4’
5’
6’
7’
Height (Inches)
0”
1”
2”
3”
4”
5”
6”
7”
8”
9”
10”
11”
Eye Color
*
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:
Legal Status
Legal Status
*
Legal Status
US Citizen
Legal Permanent Resident
Qualified Alien or Non-Immigrant lawfully present in the US
Alien Registration number OR I-94 number for non-citizens
*
Step 3:
Answer Each Question
What can we help you with today?
*
Service
License/Permit
Identification Card
Reinstatement
Have you ever had a GA, Out-of-State or Foreign Driver's License, Identification Card or Permit?
*
Yes
No
If
Yes
, please list the most recent
(a)
State or Country and
(b)
Name on Card:
*
1.
2.
Is your Driver's License, Permit or privilege to drive currently revoked, suspended, cancelled or denied?
*
Yes
No
If
Yes
, list most recent:
*
State:
Action:
Date of Action:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
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Year
2024
2023
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2020
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2016
2015
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1930
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1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Did you bring your GA, Out-of-State or Foreign Driver's License, Identification Card or Permit with you today?
*
Yes
No
If
No
, why?
*
Reason
A Law Enforcement/Official has it
It is damaged, lost or stolen
New Customer
Do you wear prescription glasses or contact lenses for driving?
*
Yes
No
Have you ever suffered with: Seizures, Fainting or Other Loss of Consciousness?
*
Yes
No
If
Yes
, please list Date of Last Episode
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
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Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Were you born on the same date (month/day/year) as any of your brothers and/or sisters AND/OR do you have any identical siblings?
*
Yes
No
If
Yes
, please list their full name(s)
*
Would you like to have "Organ Donor" displayed on your license or ID?
*
Yes
No
Would you like to donate $1 to the Georgia Drive for Sight Program for the prevention of blindness?
*
Yes
No
Would you like to donate to the Georgia Student Finance Authority for educational aid to children whose parents are/were public safety employees and were disabled or killed in the line of duty?
*
Yes
No
If
Yes
, how much?
*
Amount
$1
$5
$10
Are you a male U.S citizen or immigrant under age 26?
*
Yes
No
If
Yes
, have you registered with the Selective Service System?
*
Yes
No
Are you a veteran?
*
Yes
No
Do you have diabetes requiring treatment by insulin?
*
Yes
No
Step {( currentStep )}:
Payment Information
Billing Name
*
Billing Address
*
The billing address and ZIP must match your credit card.
State
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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
---
01
02
03
04
05
06
07
08
09
10
11
12
EXPIRY YEAR
---
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
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2044
SECURITY CODE
Drivers License Application Guide and Pre-Filling Total:
$34.95
Discount Shopping Club Membership Total:
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