Drive America Select | Driven SolutionsDriven Solutions

Enrollment - QA

Membership Desired - QA

Drive America Select Individual

$9.95/month

$115.00/year

Drive America Select Family

$11.95/month

$140.00/year

Repair Assist w/12 Mon Maintenance

$39.99/month

$475.00/year

personal information

First Name*

Last Name*

Email Address*

Street Address*

Apt/Unit

City*

State*

ZIP Code*

Cell Phone*

Work Phone

*Required Field

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Dependents

Spouse First Name

Last Name

Eligible Children

Child's First Name

Last Name

Child's First Name

Last Name

Child's First Name

Last Name

Child's First Name

Last Name

Child's First Name

Last Name

Child's First Name

Last Name

Child's First Name

Last Name

Child's First Name

Last Name

Child's First Name

Last Name

Child's First Name

Last Name

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Vehicle Information

Primary Vehicle Year

Primary Vehicle Make

Primary Vehicle Model

Primary Vehicle VIN

credit card information

Credit Card*

Name On Credit Card*

Credit Card Number*

Expiration Month*

Expiration Year*

By clicking “Submit”, I consent for Drive America or it's partners below" to call, text or email me (using the contact information provided above) with additional information and offers. I understand that communications may be sent using an automated dialing system and that consent is not a condition of purchase. I also agree to the privacy policy.

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Enrollment - QA

Membership & Billing Terms