On-the-Spot License Renewal Request Form
Please complete the On-the-Spot License Renewal Request Form to submit your renewal request. All fields are required to process your request promptly.
Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Current License Type
*
Please Select
Standard
Commercial
Motorcycle
Provisional
Other
Current License Expiry Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Renewal Appointment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Reason for Renewal
*
Please Select
License expiring soon
Lost or stolen license
Damaged license
Change of information
Other
Preferred Pickup Method
*
In-person pickup
Mail delivery
Additional Notes or Special Instructions
Submit Renewal Request
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