Please fill in the following information and click on
"Send Your Order", or print this form and mail to:
Madison Heights, MI 48071
*SHIPPING NOTE: Outside of the Continental U.S., actual shipping costs will be charged. You will be contacted to approve these costs prior to shipment.*
The information you have filled in, is for verification only. The printing of your name and your specific profession, will be determined by information obtained from the State of Michigan database for professionals. If the address on your license does not match the Billing Address , please check the "Address Correction" box.
Special Instructions: Gift Note/Comments: