Order Form for License Plate

Please print out order form and mail to the address at the bottom of the page.
ORDER FORM FOR PENNSYLVANIA COMMEMORATIVE GETTYSBURG LICENSE PLATE
(Please print)

NAME:________________________________________

STREET ADDRESS: __________________________________________________________

CITY: ________________________________ STATE: __________

ZIP CODE: ___________

PHONE: (____) ________________

QUANTITY: _______________

AMOUNT OF ENCLOSED CHECK: _____________________
Cost of each plate is $20.00 plus $4.00 Shipping and Handling.

Please make checks payable to:
PA GETTYSBURG MONUMENTS PROJECT

Mail to:

REP. Harry Readshaw
Room 122 South Office Bldg.
Harrisburg, PA 17120