Fillable Form 4.: Application for Standard Collector Plates (mail (Michigan)

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Form 4.: Application for Standard Collector Plates (mail (Michigan)

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Application for Standard Collector Plates (mail orders only)
1. Cost: $10 per plate.
2. Collector plates cannot be used for vehicle registrations. The collector plates are for display purposes only.
3. Enter your full name, driver's license number, telephone number, and address at the bottom of this form.
4.
Make your check or money order payable to the State of Michigan. Mail the completed form and your payment to the
Michigan Department of State, Internal Services Section, Lansing, MI 48918.
Enter the number of plates you wish to order in the box next to the plate image.
Pure Michigan
Great Lakes Splendor
Amateur Radio Operator
Graphic
Pure Michigan
Great Lake State 1979
Standard
Black-and-white
Pure Michigan
Water-Winter
Historical
Wonderland
Mackinac Bridge
Pure Michigan Mackinac Bridge
Motorcycle Motorcycle
Total number of plates ordered: (x $10 per plate) = TOTAL DUE:
Name:
Daytime telephone number:
Driver's license number:
Street address:
City:
State: ZIP code:
Standard Collector Plate
Order Form (Rev. 01/2022)
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Form 4.: Application for Standard Collector Plates (mail (Michigan)

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Completed 9 May 2022

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