New account

$10 Florida Senior

New account

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Choose your username and password

Username

The password must have at least 8 characters:
- at least one upper-case letter
- at least one lower-case letter
- at least one number
- at least one of these symbols: ! @ # $ %

Password

Name & Email

Email address

Email (again)

First name

Middle name or initial (optional)

Last name

Other fields

Date of Birth

Gender

Driver's License Number

Phone Number

Is your DOB correct?

Is your driver's license number correct?

Is your name spelled correctly?

"I understand that if there are any mistakes in my profile, that I will need to pay $10 to have my certificate corrected." (Take one more look...)

State License Number

Security Questions

Which of these is your favorite color?

Which of these is your natural hair color?

Which of these is your eye color?

Which of these is your middle initial?

Do you wear corrective lenses?

Site policy agreement

Link to site policy agreement

I understand and agree

There are required fields in this form marked .