Mail Order Form

Note:  Free shipping applies only to orders placed online.
Please print this order form, fill in your order and mail with payment, to

PlatesUSA, 4 Moors Circle, Scituate, MA 02066   USA   (or fax this form to  801-340-3199)

SHIP TO:

Name:

Address:

Address:

City:

State or Province:

Zip code or Postal Code:

Country:

E-mail address:

Payment By: (circle)

Check,  Money Order,  Visa,   MasterCard,  American Express,   Discover

Credit Card Number:

Expiration Date:

Name on Credit Card: (if different)

Billing Address: (if different):

Merchandise Total:

  $
5% Sales Tax (Massachusetts only)

  $

Shipping Cost:

   $

TOTAL ENCLOSED: 

  $

 

  ALL MAIL ORDERS MUST INCLUDE SHIPPING CHARGE.
  Orders that do not include shipping will not be sent.

Calculate SHIPPING CHARGE:

To USA addresses:

  Shipping charge is $4.95 PLUS $0.50 per plate or item ordered. 

Outside USA:

See Shipping Costs and Country List

Number of Items Ordered:

Please write in your order below.

License Plate or Product Name Product Code Price Quantity Total 
(US $)

Thank You for your order!