tag_application - Downtown Jimmie Hale Mission, Inc.

 

Commitment to Purchase Application for Distinctive License Plates

Please complete this form in its entirety and the Jimmie Hale Mission will cover the registration cost for each vehicle (up to five per application) for the first year!

"*" indicates required fields

Name of Applicant (Must be Owner or Co-Owner of Vehicle*
Address*
Email (where your license plate voucher will be sent)*
State of Issuance*
Personalized plates (4JESUS, etc.) are free on Alabama distinctive plates, but can't be reserved until the tag is in production. Checking this box simply informs the state of your plan to do so.
Number of vehicles you are requesting plates for

VEHICLE INFORMATION:

Please enter all requested information for each vehicle you which to submit for pre-commitment.

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle 5

Please select one of the following:*
Consent*
Use your device's mouse or touch screen to sign.
MM slash DD slash YYYY

Power of Attorney

I appoint Jimmie Hale Mission as my attorney-in-fact to process commitment to purchase application(s) in my name for the purpose of creating the Jimmie Hale Mission distinctive license plate category.
Use your device's mouse or touch screen to sign.
MM slash DD slash YYYY
Use your device's mouse or touch screen to sign.
MM slash DD slash YYYY
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