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License Order Form

Application for a NCHC License Plate

 

Select Type
Regular NCHC - $20.00
Personalized - $50.00.

 

NOTE: When applying for a Personalized NCHC license plate, bear in mind the letters representing the NC Horse Council must still be the last letters on the plate. This leaves only four spaces for a personalized message. Therefore, spaces may be a combination of letters and numbers, but cannot conflict with another classification of license plates.

 

First choice:

 

Second choice:

 

IF PERSONALIZED NCHC DESIRED, LIST THE CHOICES IN ORDER OF PREFERENCE.
REMEMBER, SUFFIX IS THE LAST TWO LETTERS ON THE LICENSE PLATE

 

The $20/$50 Special Fee is an Annual Fee due in addition to the regular license fee.

 

Name
(To agree with certifcate of title):

Address:

City:

State:

Zip:

Current North Carolina Plate #:

Driver License #:

Vehicle Identification Number:

Year:

Make:

Model:

Body Style:

Home Phone:

Office Phone:

Email Address:

I certify for the motor vehicle described above that I have financial responsibility as required by law.

 

Full name of Insurance Company Authorized in NC -- Not Agency or Group:

Policy Number:

Your Initials:

Date of Certification:

 

NOTE: Three hundred plates must be sold prior to production. Please fill in the form and submit with payment.
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