Georgia License Plate Application Form
Complete the special interest application and remit the $30 manufacturing fee via check, CashApp, or PayPal. You MUST be a current Georgia resident to receive an MBC License Plate at this time. Residents of states outside of Georgia will have their form voided. See payment details on next page.

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Full Legal Name *
Please include your full legal name (First Name, Middle Initial, Last Name, Suffix)
Mailing Address *
Please include your FULL mailing address (street, city, state and zipcode)
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Telephone Number *
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Email Address *
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