Marine Corps League                        
                    Custom License Plates Order Form 
                	
Vechicle must be registered in the members name                       	
Current NY License Plate# ______________ 
Vehicle Class ________________ (Passenger/Commercial)

Name_____________________   ____________________   ___________
                   (Last)                                (First)                       (Middle)

Mailing Address_______________________________________________

City____________________      State_______________    Zip Code_____

Daytime Phone #____________ Ext____ Date of Birth__________ Sex___ 
Membership Certification 

Marine Corps League Member #__________ Expiration Date___________

Detachment Name ____________________________________________

 Regular numbered plate: (###MCL) Initial Cost: $28.75  
After the first year the annual cost to renew is $50.00 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 $0 plus the standard registration fee (billed every 2 years)
A maximum of six spaces is allowed for any combination of letters, numbers or blank spaces. Please enter up to 3 choices of personalization with choice 1 being your most preferred.
_ _ _ _ _ _     _ _ _ _ _ _   _ _ _ _ _ _
     First Choice                         Second Choice                 Third Choice

Method Of Payment:                        (Please Check One)
___ Check   ___ Money Order ___ Mastercard ___ Visa
___DMV Gift Certificate
Name as it appears on your credit card: ____________________________
Credit Card # _ _ _ _/_ _ _ _/_ _ _ _/_ _ _ _   Experation Date_________

Authorized Signature_________________________________________

Mail this application to the Department Paymaster:
                                Robert E. Becker, Paymaster
                                6 Lent Court Apt. #5
                                Schenectady, NY 12306

Make checks payable to:
Commissioner of Motor Vehicles
This is to certify that this person is authorized to receive the Marine Corps League organizational plate.

 Approved_____________________________
                    Robert E. Becker, Paymaster    Plate # Assigned _ _ _ _ _ _
* Information about handicapped plates, contact the Custom Plates Unit at 518-402-4838