Protect Wildlife Tag Form - Alabama Wildlife Center

Name of Applicant (must be owner or co-owner of vehicle)

Number of vehicles on this application

Mailing Address

City

State

Zip Code

County

Phone

Email

Will this plate be personalized?

Yes

No

State of Issuance

Automobile #1

Make of Vehicle 1

Model of Vehicle 1

Vehicle Year 1

Vehicle Identification Number (VIN) 1

License Plate #1 (Your current license plate number)

Automobile #2

Make of Vehicle 2

Model of Vehicle 2

Vehicle Year 2

Vehicle Identification Number (VIN) 2

License Plate #2 (Your current license plate number)

Automobile #3

Make of Vehicle 3

Model of Vehicle 3

Vehicle Year 3

Vehicle Identification Number (VIN) 3

License Plate #3 (Your current license plate number)

Automobile #4

Make of Vehicle 4

Model of Vehicle 4

Vehicle Year 4

Vehicle Identification Number (VIN) 4

License Plate #4 (Your current license plate number)

Automobile #5

Make of Vehicle 5

Model of Vehicle 5

Vehicle Year 5

Vehicle Identification Number (VIN) 5

License Plate #5 (Your current license plate number)

Opt-In

Opt-in – Yes, I authorize the release of my name, address, and email address to the sponsoring organization of a distinctive license plate.

Opt-Out – No, I restrict the release of my name, address, and email address to the sponsoring organization of a distinctive license plate.

I certify that the information listed above is true and correct. I own/lease the vehicle(s) described.

Yes

Use your mouse or touchscreen to digitally sign in the locations below. Or click the keyboard icon to use your keyboard to type in your name.

Signature of Applicant (Use your device’s mouse or touch screen to sign.)

Clear

Date

Power of Attorney I appoint Alabama Wildlife Center as my attorney-in-fact to process commitment to purchase application(s) in my name for the purpose of creating the Alabama Wildlife Center distinctive license plate category.

Signature of Vehicle Owner/Lessee: Use your device’s mouse or touch screen to sign.

Clear

Date

Signature of Vehicle Owner/Lessee: Use your device’s mouse or touch screen to sign.

Clear

Date