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00PLT-TSHRT Merchandise Order Form 00GCL-LPLPIN-E 00PLT-BLKCAP-E 00PLT-BLKMUG-E 00PLT-APATCH-E We Support I-CAR Training banner Platinum Individual merchandise can only be purchased by businesses and individuals that hold these designations. Sold to I-CAR ID Name First Last and/or Gold Class ID E-mail address Address No P. O. Boxes Please Phone Company Fax City State ZIP Code Send to Same as above Qty Description and Size Part number Price Amount 00PLT-PSHRTS-E 32. 00 13. 00 00000-BANNER-E Other 14. 50 33. 50 30. 00 SUBTOTAL All prices include tax 7 added for shipping TOTAL Payment Information Mail form and payment or fax form and credit card information to I-CAR Training Support Center 5125 Trillium Blvd. Hoffman Estates IL 60192 Phone 800. 422. 7456 Fax 800. 590. 1215 Check or Money Order Make payable to I-CAR Credit Card Visa Mastercard AMEX Amount to Charge Card Holder s Name Please print Credit Card Number Send receipt Exp* Date Security Code Card Holder s Signature Billing Address. Sold to I-CAR ID Name First Last and/or Gold Class ID E-mail address Address No P. O. Boxes Please Phone Company Fax City State ZIP Code Send to Same as above Qty Description and Size Part number Price Amount 00PLT-PSHRTS-E 32. 00 13. 00 00000-BANNER-E Other 14. 50 33. 50 30. 00 SUBTOTAL All prices include tax 7 added for shipping TOTAL Payment Information Mail form and payment or fax form and credit card information to I-CAR Training Support Center 5125 Trillium Blvd. 00 13. 00 00000-BANNER-E Other 14. 50 33. 50 30. 00 SUBTOTAL All prices include tax 7 added for shipping TOTAL Payment Information Mail form and payment or fax form and credit card information to I-CAR Training Support Center 5125 Trillium Blvd. Hoffman Estates IL 60192 Phone 800. 422. 7456 Fax 800. 590. 1215 Check or Money Order Make payable to I-CAR Credit Card Visa Mastercard AMEX Amount to Charge Card Holder s Name Please print Credit Card Number Send receipt Exp* Date Security Code Card Holder s Signature Billing Address. Sold to I-CAR ID Name First Last and/or Gold Class ID E-mail address Address No P. O. Boxes Please Phone Company Fax City State ZIP Code Send to Same as above Qty Description and Size Part number Price Amount 00PLT-PSHRTS-E 32. 00 13. 00 00000-BANNER-E Other 14. 50 33. 50 30. 00 SUBTOTAL All prices include tax 7 added for shipping TOTAL Payment Information Mail form and payment or fax form and credit card information to I-CAR Training Support Center 5125 Trillium Blvd. Hoffman Estates IL 60192 Phone 800. 422. 7456 Fax 800. 590. 1215 Check or Money Order Make payable to I-CAR Credit Card Visa Mastercard AMEX Amount to Charge Card Holder s Name Please print Credit Card Number Send receipt Exp* Date Security Code Card Holder s Signature Billing Address. .

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