License Plate Shop Mail / Fax Order Form

License Plate Shop

Billing Name and Address:

Name: ___________________________________________

Address: _________________________________________________

_________________________________________________

State:___________ Zip: ___________

Shipping Address: (if different than above)

Name: _____________________________________________

Address: ___________________________________________

_______________________________________________

State: __________ Zip: __________

Phone: (_______)_______________________

Sub Total of Order:

$__________________________________

Shipping Charges: (Please Check Rate Table)

$__________________________________

Total Amount Due: (Include your check or money order)

$__________________________________

Credit Card Number and Expiration Date:
(Required for Fax Orders or If you do not wish to pay by Check)

____________________________________________________________________

Comments if Any:

____________________________________________________________________

Mail To: License Plate Shop
PO Box 515 Virginia City, NV 89440-0515

Fax Number 775-201-0033 (Please Provide Credit Card if Faxing Your Order)

Return to Home Page (Click Here)