MARINE CORPS LEAGUE – CUSTOM PLATES ORDER FORM

Mail to:
Robert E. Becker, Paymaster

6 Lent Court #5
Schenectady, NY 12306

Current NY Vehicle Plate#________________ Vehicle Class ______________________ (Passenger / Commercial)

NAME _____________________________ ___________________________ __________________

(LAST) (FIRST) (MIDDLE)

Mailing Address: ____________________________________________________________________________________

City _________________________________ State _____________________________ Zip Code _______________

Day Time Phone: ______________________ Ext. __________ Date of Birth ________________ Sex __________

Detachment________________________________________________________ Membership Number__________________

STANDARD PLATE (###MCL) Initial Cost: $28.75

After the first year, the annual cost to renew is $.00 plus the standard registration fee (billed every 2 years).

Personalized Plate (_ _ _ _ _ _) Initial Cost: $60.00

After the first year, the annual cost to renew is $50.00 plus the standard registration fee (billed every 2 years)

A maximum of six (6) spaces is allowed for any combination of letters, numbers or blank spaces.

Please enter up to three (3) choices of personalization with choice one (1) being your most preferred.

1^st Choice __ __ __ __ __ __ 2^nd Choice __ __ __ __ __ __ 3^rd Choice __ __ __ __ __ __

Name as it appears on your credit card _____________________________________________________________________

Credit Card # __ __ __ __/ __ __ __ __/ __ __ __ __/ __ __ __ __ Expiration Date ___________

Membership Certification Vehicle must be registered in the members name.

Approved _______________________________________ Plate # assigned __ __ __ __ __ __

* Information about handicapped plates, contact Custom Plates Unit at: 1-518-402-4838