Request To Purchase By Check Or Cash Form

Paying By Check

Make Checks Payable to EAA Chapter 944

Name: ______________________________________ Date:_________________

Street/PO: _____________________________________

City: ________________________ Zip: ______________

Email: _______________________________________________________________

Check#____________ Check Amount: $__________

Number of Plates:

One Year Plates ($25.00 each): __________ Two Year Plates ($50.00 each): __________

 

*** OR ***

Paying By Cash

Name: ______________________________________ Date:_________________

Street/PO: _____________________________________

City: ________________________ Zip: ______________

Email: _______________________________________________________________

Cash Amount inclosed: $__________

Number of Plates:

One Year Plates ($25.00 each): __________ Two Year Plates ($50.00 each): __________

Submit payment and form to:

Cathie Hamilton

510 Eleventh St.

Chillicothe, MO 64601