Name_________________________________

Address_______________________________

City__________________________________

State_____________Zip_________________

Phone Number (____)__________________

PROFESSIONAL CAR SOCIETY LICENSE FRAMES

Quantity ________ X $20.00 = _______

Ohio Residents Add Sales Tax 5.75% _______

US Priority Mail Shipping for the first license frame set only $8.00

Each additional license frame set $1.00 X

International Shipping Charges _______

OHIO CHAPTER PATCHES

Quantity ________ X $6.00 = _______

Ohio Residents Add Sales Tax 5.75% _______

Note there is no charge for shipping patches

Total ________

Make checks or money orders out to "Ohio PCS"

Send to:

Ohio PCS

3060 Kent Road

Silver Lake, OH 44224