Lost Key Locator Order Form J261


"During the order process be sure to add your plate # and name in the information field"

Or.....

(print out this form, fill out and mail to address below with remittance)

PERSONAL INFORMATION
NAME: __________________________________
ADDRESS: _______________________________
CITY: __________________________________
COUNRY: (circle one)....USA.....CANADA
STATE OR PROVINCE: ______________________
ZIP CODE: _______________________________

PRINT CLEARLY your license Plate # and Name information:
(Maximum 7 letters or numbers per plate and per name)


PLATE #1: ___________
PLATE #2: ___________
PLATE #3: ___________
PLATE #4: ___________
(write additionals on back)

NAME: ______________
NAME: ______________
NAME: ______________
NAME: ______________
(write additionals on back)

Multiply the number of tags you ordered by $19.95 and
send payment (in U.S. funds) to:
Jerry's P. S., Inc.
P. O. Box 554 - Dept. TAGS
Bridgeport, Michigan USA 48722-0554
(please allow 1-3 weeks for delivery)

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P. O. Box 554, Bridgeport, Michigan 48722-0554

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