Form MV-299.4 Receipts and Contracts - New York

Form MV-299.4 is a New York State Department of Motor Vehicles form also known as the "Receipts And Contracts". The latest edition of the form was released in October 1, 2015 and is available for digital filing.

Download an up-to-date Form MV-299.4 in PDF-format down below or look it up on the New York State Department of Motor Vehicles Forms website.

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RECEIPTS AND CONTRACTS
Bureau of Driver Training Programs
Commissioner Regulations Part 76.8,
Records and Contracts
Highlights Regarding
RECEIPT [Section 76.8 (a)(3) and (d)]
A receipt is to be
issued each time money is paid.
Every receipt must show:
u
Name and address of the school
u
Amount paid
u
Duration of each lesson
u
Receipt number
u
Service rendered
u
Signature of an authorized representative of
u
Name of student
u
Contract number, if any
the school
u
Date of payment
The name and address of the school, and the receipt number, must be preprinted. Receipt numbers must be in sequence. The original
receipt is given to the student; the duplicate is retained by the school in numeric order. Each contract or, if no contract is used, each
receipt issued to a student, must include the following statement concerning refunds:
(1) Except for contracts executed by schools licensed by the New York State Education Department and subject to the refund
provisions of regulations promulgated by that Department, prepayment for lessons and other services shall be subject to refund
as follows: if the student, having given prior notice of at least 24 hours, withdraws from or discontinues a prepaid course of
instruction or series of lessons before completion thereof, or from any other service for which prepayment has been made, or
if the school is unable or unwilling to complete such prepaid course of instruction, or series of lessons, or to provide such other
prepaid service, all payments made by the student to the school shall be refunded except:
(i) an amount equal to the enrollment fee, if any, specified in the contract or expressly receipted for, not to exceed the sum of
$10 or 10 percent of the total, whichever is greater, specified cost of such course of instruction or series of lessons;
and
(ii) the school’s per-lesson tuition charge for each lesson already taken by the student which charge shall be determined by
dividing the total cost of such course of instruction or series of lessons by the number of lessons included therein.
See page 2 of this form for a fill-in, printable receipt (two receipts per page) that you may use. If your school is incorporated (Inc.),
you
include the name of the owner (or proprietor, or at least one officer of the corporation) of the school at the top of the receipt,
must
under the school’s address.
To conform to Part 76 of the Commissioner’s Regulations, you may use the receipt on page 2 in the following ways:
1. You may fill in the school’s name, address, and proprietor or principal officer (if required) online, and then
a. print the filled-in receipts with an office printer,
OR
b. take a printed copy to a print shop for printing.
OR
2. You may print the online receipt without filling in the name/address/proprietor/principal officer block, and
a. use a stamp containing this information to stamp the top of each office-printed receipt,
OR
b. take a copy with the name/address/proprietor/principal officer stamped on the top to a print shop for printing.
No matter which way (above) you may choose to use the receipt on page 2 of this form,
Note:
the receipt numbers must be
preprinted in sequence.
PAGE 1 OF 3
MV-299.4 (10/15)
RECEIPTS AND CONTRACTS
Bureau of Driver Training Programs
Commissioner Regulations Part 76.8,
Records and Contracts
Highlights Regarding
RECEIPT [Section 76.8 (a)(3) and (d)]
A receipt is to be
issued each time money is paid.
Every receipt must show:
u
Name and address of the school
u
Amount paid
u
Duration of each lesson
u
Receipt number
u
Service rendered
u
Signature of an authorized representative of
u
Name of student
u
Contract number, if any
the school
u
Date of payment
The name and address of the school, and the receipt number, must be preprinted. Receipt numbers must be in sequence. The original
receipt is given to the student; the duplicate is retained by the school in numeric order. Each contract or, if no contract is used, each
receipt issued to a student, must include the following statement concerning refunds:
(1) Except for contracts executed by schools licensed by the New York State Education Department and subject to the refund
provisions of regulations promulgated by that Department, prepayment for lessons and other services shall be subject to refund
as follows: if the student, having given prior notice of at least 24 hours, withdraws from or discontinues a prepaid course of
instruction or series of lessons before completion thereof, or from any other service for which prepayment has been made, or
if the school is unable or unwilling to complete such prepaid course of instruction, or series of lessons, or to provide such other
prepaid service, all payments made by the student to the school shall be refunded except:
(i) an amount equal to the enrollment fee, if any, specified in the contract or expressly receipted for, not to exceed the sum of
$10 or 10 percent of the total, whichever is greater, specified cost of such course of instruction or series of lessons;
and
(ii) the school’s per-lesson tuition charge for each lesson already taken by the student which charge shall be determined by
dividing the total cost of such course of instruction or series of lessons by the number of lessons included therein.
See page 2 of this form for a fill-in, printable receipt (two receipts per page) that you may use. If your school is incorporated (Inc.),
you
include the name of the owner (or proprietor, or at least one officer of the corporation) of the school at the top of the receipt,
must
under the school’s address.
To conform to Part 76 of the Commissioner’s Regulations, you may use the receipt on page 2 in the following ways:
1. You may fill in the school’s name, address, and proprietor or principal officer (if required) online, and then
a. print the filled-in receipts with an office printer,
OR
b. take a printed copy to a print shop for printing.
OR
2. You may print the online receipt without filling in the name/address/proprietor/principal officer block, and
a. use a stamp containing this information to stamp the top of each office-printed receipt,
OR
b. take a copy with the name/address/proprietor/principal officer stamped on the top to a print shop for printing.
No matter which way (above) you may choose to use the receipt on page 2 of this form,
Note:
the receipt numbers must be
preprinted in sequence.
PAGE 1 OF 3
MV-299.4 (10/15)
School’s Name
Address
Proprietor or Principal O
fficer (if required)
Date:
Receipt No.
Contract No.
(must be PREPRINTED in sequence)
Received From
The Sum of $
for the following service:
o
Road Lessons - Indicate number of minutes per lesson.
o
Road Test
o
Pre-Licensing Course
o
Other
Except for contracts executed by schools licensed by the New York State Education Department and subject to the refund provisions of
regulations promulgated by that Department, prepayment for lessons and other services shall be subject to refund as follows:
if the student, having given prior
, withdraws from or discontinues a prepaid course of instruction or series of
notice of at least 24 hours
lessons before completion thereof, or from any other service for which prepayment has been made, or if the school is unable or unwilling to
complete such prepaid course of instruction, or series of lessons, or to provide such other prepaid service, all payments made by the student
to the school shall be refunded except:
(i) an amount equal to the enrollment fee, if any, specified in the contract or expressly receipted for, not to exceed the sum of $10 or 10
percent of the total, whichever is greater, specified cost of such course of instruction or series of lessons; and
(ii) the school’s per-lesson tuition charge for each lesson already taken by the student which charge shall be determined by dividing the
total cost of such course of instruction or series of lessons by the number of lessons included therein.
Signature of Student
Signature of Authorized Official
School’s Name
Address
Proprietor or Principal Officer (if required)
Date:
Receipt No.
Contract No.
(must be PREPRINTED in sequence)
Received From
The Sum of $
for the following service:
o
Road Lessons - Indicate number of minutes per lesson.
o
Road Test
o
Pre-Licensing Course
o
Other
Except for contracts executed by schools licensed by the New York State Education Department and subject to the refund provisions of
regulations promulgated by that Department, prepayment for lessons and other services shall be subject to refund as follows:
if the student, having given prior
, withdraws from or discontinues a prepaid course of instruction or series of
notice of at least 24 hours
lessons before completion thereof, or from any other service for which prepayment has been made, or if the school is unable or unwilling to
complete such prepaid course of instruction, or series of lessons, or to provide such other prepaid service, all payments made by the student
to the school shall be refunded except:
(i) an amount equal to the enrollment fee, if any, specified in the contract or expressly receipted for, not to exceed the sum of $10 or 10
percent of the total, whichever is greater, specified cost of such course of instruction or series of lessons; and
(ii) the school’s per-lesson tuition charge for each lesson already taken by the student which charge shall be determined by dividing the
total cost of such course of instruction or series of lessons by the number of lessons included therein.
Signature of Student
Signature of Authorized Official
reset/clear
reset/clear
PAGE 2 OF 3
MV-299.4 (10/15)
CONTRACT [Section 76.8(b), (c) & (d)]
A driving school may contract in writing to provide lessons and other services to a student, but must use a contract form approved by the
commissioner for such purpose.
The contract must be numbered and issued in consecutive numerical order; a duplicate must be maintained on file in numerical order;
the number of the contract must be entered on the student record card.
Each contract must contain:
Complete name and address of the school;
Provision for the use of a vehicle, or vehicles, for the student’s
u
u
road test;
u
Name of the principal officer;
u
A statement of the terms or alternative terms for payment of the
u
Contract number;
tuition fee and for payment of any enrollment or registration fee;
Statement specifying the number and duration of classroom and
u
u
Spaces for the name and address of the student, and the date of
behind-the-wheel lessons to be given other than for the prelicensing
the contract; and spaces for the signature of the student and the
course;
driving school licensee or representative;
Spaces may be provided for services which may vary on each
u
individual contract;
u
The following statement:
u
If the school offers a prelicensing course, the contract must state:
“This agreement constitutes the contract between the school and
“Contract price does not include the fee for the prelicensing course.”;
the student, and no verbal statements or promises will be
recognized.”
u
Each contract must include the following statement concerning refunds:
Except for contracts executed by schools licensed by the New York State Education Department and subject to the refund provisions
of regulations promulgated by that Department, prepayment for lessons and other services shall be subject to refund as follows:
if the student, having given prior notice of at least 24 hours, withdraws from or discontinues a prepaid course of instruction or
series of lessons before completion thereof, or from any other service for which prepayment has been made, or if the school is unable
or unwilling to complete such prepaid course of instruction, or series of lessons, or to provide such other prepaid service, all
payments made by the student to the school shall be refunded except:
(i) an amount equal to the enrollment fee, if any, specified in the contract or expressly receipted for, not to exceed the sum of $10
or 10 percent of the total, whichever is greater, specified cost of such course of instruction or series of lessons; and
(ii) the school’s per-lesson tuition charge for each lesson already taken by the student which charge shall be determined by dividing
the total cost of such course of instruction or series of lessons by the number of lessons included therein.
Full Name and Address of School
Date:
Name of Proprietor or Principal Officer
Contract No
(must be PREPRINTED in
sequence)
Contract entered into by the school and
, who resides at
, for services rendered as follows:
Behind-the-wheel lessons at
minutes each.
(Contract must include the number of lessons and duration of time per each
lesson.) The school agrees to furnish a car for instruction at no additional cost. A car for Road Test with a licensed driver is at the option of the
SAMPLE CONTRACT
student. The fee is $
.
Other Services:
The Total Contract Fee is $
and must be paid as follows:
This agreement constitutes the contract between the school and the student, and no verbal statements or promises will be recognized.
Contract price does not include the fee for the prelicensing course.
(This statement must be included on the receipt only if your school offers
the prelicensing
course.)
Except for contracts executed by schools licensed by the New York State Education Department and subject to the refund provisions of
regulations promulgated by that Department, prepayment for lessons and other services shall be subject to refund as follows:
if the student, having given prior notice of at least 24 hours, withdraws from or discontinues a prepaid course of instruction or series of lessons
before completion thereof, or from any other service for which prepayment has been made, or if the school is unable or unwilling to complete
such prepaid course of instruction, or series of lessons, or to provide such other prepaid service, all payments made by the student to the
school shall be refunded except:
(i) an amount equal to the enrollment fee, if any, specified in the contract or expressly receipted for, not to exceed the sum of $10 or 10 percent
of the total, whichever is greater, specified cost of such course of instruction or series of lessons; and
(ii) the school’s per-lesson tuition charge for each lesson already taken by the student which charge shall be determined by dividing the total
cost of such course of instruction or series of lessons by the number of lessons included therein.
*
X
Signature of Student
:
Date:
*
If the student is under 18 years of age, the contract must instead be signed by the student’s parent/guardian/person in loco parentis who is
18 years of age or older.
X
Signature of School Representative:
Date:
PAGE 3 OF 3
MV-299.4 (10/15)

Download Form MV-299.4 Receipts and Contracts - New York

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