Novelty Number Plate Order Form
Please complete all required sections to place your order.
Don’t fill this out if you're human:
1. Customer Contact
Customer Name
Contact Number
Email Address
Date of Order
2. Plate Details
Text / Combination Requested (Max 6 letters/numbers + 1 hyphen)
Plate Type & Price (Select One)
Standard Plate
$280
Slimline Plate
$250
Motorcycle Plate
$200
Plate Colour (Select One)
White on Black
Blue on White
3. Customer Agreement
I, the undersigned, confirm that I **understand and agree** to the disclaimer and payment terms.
Name (Print) - Required
Date - Required
Submit Order