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 SplendorAmateur 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)