Online payment and access to application

Basic Information

Application Type:

Last Name:

First Name:

Middle Name:

Social Security Number (last 4 digits):

Email:

Name as you wish it to appear on your license:

If you have ever been licensed in NC before, please list your previous license number:

Date of Birth:

Gender:

MaleFemaleOther

Are you a citizen of the United States:

YesNo

Mailing Address

Address:

City:

State:

Zip:

County:

please enter a valid NC county

Home Phone:

Cell Phone:

4140 ParkLake Ave,
Suite 100
Raleigh, NC 27612

Office 919-832-1380