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I.D. IT! Plate Retail Order Form #8991

Customer Information

Company Name __________________________________________________

Your Name ______________________________________________________ 

Address ________________________________________________________

City ____________________________________________________________

State/Prov ______________ Zip Code _________  Country _______________

Telephone______________Fax______________ Email __________________

Please tell us your referring partners ID #   ________

Shipping Address same as above, or:

Address ________________________________________________________

City ____________________________________________________________

State/Prov ______________ Zip Code _________  Country _______________

QUANTITY  _______       TYPE:   {   } Chrome         {   } Gold

TEXT "EXACTLY" AS YOU WOULD LIKE YOUR PLATES TO READ 
(remember, 22 character limit - use other side for additional plates)

Plate 1:  ____________________________________________

Plate 2:  ____________________________________________

Plate 3:  ____________________________________________

Plate 4:  ____________________________________________

 TOTAL PRICE OF YOUR ENTIRE ORDER: $ (U.S.) _____________

Payment Method:  Visa  MC   AMEX  Business Check  Money Order
(make money orders or business checks payable to "Rick Beneteau" and send this form to:
I.D. IT! Plates, The Pine Aire Waterfront Towers, 1385 Riverside Dr. W., Suite 907
Windsor, Ontario Canada N9B 3R9

Credit Card # ________________________________Expiration _______________