What is your name?
(Full please)
Address?
Street:       
Suburb:     
City:          
Postcode:
 
Contact Number/s:
Email Address?
Drivers Licence Number:

What colour would you like the text and border colour to be? Black Dark Blue Dark Green Maroon Pink Purple Red Royal Blue What's this?

Are these club plates replacement for existing plates, or completely new plates?
  Replacement New What's this?

What is the existing/new combination?

Do you require a slimline front plate?
  Yes No
(Slimline plates are no cost extra.)

Any comments?
Once this form is sent, you will receive a call from a club member to confirm all details, and to arrange for payment of the plates.
You must be a Club member to receive the plates.
Do not order the club plates from PPQ. They must be ordered through the club. The plates, once paid for, will be sent to your home address via certified Australia Post. If you wish to place them on your car, you must take the new plates, and the old ones, to a Department of Transport office and fill out the appropriate forms and have them placed on the car. Please check with your local office.