DAZ.PL8.com - Your License Plate by Year Headquarters
_____________________________________________________________ Date: __/__/08
Ordered By:                           Ship To: (If different)
Name...:_                             Name...:_
Address:_                             Address:_
        _                                     _
City...:_                             City...:_
State..:___                           State..:___
ZIP....:_                             ZIP....:_
Country:_                             Country:_
Phone# :(  ) ____-_____       
e-mail :_______________

[x] I have read the FAQ file and agree to the terms for ordering.
+---+-----+-----------------------------+-------------+--------+-----+-----+
|Sta|Year |Type and Description/Motto   |Colors       |Plate # |Grade|Price|
+---+-----+-----------------------------+-------------+--------+-----+-----+
| AL  1961 Passenger Heart of Dixie      White on Blac XXX-000  VG+  $00.00 
+---+-----+-----------------------------+-------------+--------+-----+-----+
|
+---+-----+-----------------------------+-------------+--------+-----+-----+
| 
+---+-----+-----------------------------+-------------+--------+-----+-----+
|
+---+-----+-----------------------------+-------------+--------+-----+-----+
| 
+---+-----+-----------------------------+-------------+--------+-----+-----+
|
+---+-----+-----------------------------+-------------+--------+-----+-----+
|
+--------------------------------------------------------------------+-----+
|         |                                          Plates Subtotal |  
+---------+----------------------------------------------------------+-----+
|         |                                          Small Order Fee | 1.00|
+---------+----------------------------------------------------------+-----+
|         |                                     Shipping (See below) | 
+---------+----------------------------------------------------------+-----+
|         |                                            Cash Discount |
+---------+----------------------------------------------------------+-----+
|         |                                                Insurance |
+---------+----------------------------------------------------------+-----+
|         |                                            Taxable Total |
+---------+----------------------------------------------------------+-----+
|         |                      Texas Residents add 8.25% Sales Tax |
+---------+----------------------------------------------------------+-----+
|         |                                                    Total | 
+---------+----------------------------------------------------------+-----+
 
Small Order Fee: Add $1 If plates total less than $25
Shipping.......: U.S. Addresses. (E-mail for rates outside the U.S.)
   1    plate  = $3.50 plain envelope (or $5.00 for a padded box)
   2-4  plates = $5.50
   5-6  plates = $7.00
   7-8  plates = $8.00
   9    plates = $9.00 
 10-49  plates = $11.00 
 50-99  plates = $15.00 
Cash Discount..: Take $1 off if paying by cash/check/money order
Insurance......: $2.00 per order (optional)
Sales Tax......: Only if shipped to a Texas Address
**********************************************************************
Thank You for your Order.      Your satisfaction is guaranteed!
 
How did you hear about DAZ.PL8.com?

[ ] Recommended by friend/previous customer
[ ] Link from web page: ________________________________
[ ] Internet Search Engine - Name:______________________
[ ] Other:______________________________________________

*****End of text order form*****