ORDER FORM

U.S. Virgin Island 2004 Olympic License Plate

Mail to:

Motor Vehicle License Systems
26841 Oak Hollow Road
Laguna Hills, CA 92653-7510
mvls@earthlink.net

Please send me ______Limited Edition numbered Olympic Plates at $50 per pair, plus $6 for shipping.

Please send me ______Personalized Olympic Plates at $65 per pair, plus $6 for shipping.

First Choice

Second Choice

Enclosed is my check or money order for $______payable to MVLS.

NAME________________________
ADDRESS____________________
CITY_________________________
STATE ZIP CODE_______________
TELEPHONE ( __)______________