SPECIALTY LICENSE PLATE FUNDRAISER ORDER FORM
Email address *
FIRST AND LAST NAME *
Your answer
MAILING ADDRESS *
Your answer
PHONE *
Your answer
IS THIS A MOBILE NUMBER? *
DRIVERS LICENSE NUMBER *
Your answer
CURRENT LICENSE PLATE NUMBER *
Your answer
LICENSE PLATE EXPIRATION DATE (MM/YY) *
Your answer
VEHICLE TYPE (CHECK ONE; MULTIPLE ORDERS WILL NEED ADDITIONAL FORM) *
Required
IS THIS AN ILLINOIS PLATE? *
IF 'NO' YOU CAN STILL ORDER BUT PLATES WILL NOT BE SHIPPED UNTIL 12/1/18.
YOU MAY HAVE 5 LETTERS OR LETTER/NUMBER COMBINATION WITH LETTERS FIRST. 1ST CHOICE: *
Your answer
SECOND CHOICE: *
Your answer
THIRD CHOICE:
Your answer
GO TO OUR WEBSITE TO PAY ONLINE, OR MAIL CHECK OR MONEY ORDER PAYABLE TO BRIGHT STAR EQUESTRIAN CENTRE TO: Bright Star Plate Fundraiser, c/o Kim Rebbe, 17363 Southview Rd., Petersburg IL 62675 **ALL PAYMENTS ARE DUE JLY 6TH TO BE PROCESSED** *
Required
QUESTIONS?
Call Kim at 217-652-7912 or email skrebbe@sbcglobal.net
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms