Survey - COA Specialty Tag Registration - Internal

COA Specialty Tag Registration - Internal

Thank you for your support! Children's of Alabama will submit all registrations in bulk to the State of Alabama. Please fill out the information below to register for your tag. All information will be kept secure and private.

Children's will pay the specialty tag fee for the first year for anyone that signs up through June 30 (not including annual taxes and tag fees). The specialty fee is $50, of which $41.25 benefits Children's. You do not have to wait for your renewal month to register.

Registrant Information:

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Name:

Title	First Required	Last Required

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Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

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Phone Number: Required

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Question - Required - County:

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Question - Required - Will this license plate be personalized?

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Question - Required - Current License Plate Number:

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Question - Required - State of Issuance:

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Question - Required - Make of Car:

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Question - Required - Model of Car:

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Question - Required - Vehicle Year:

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Question - Required - Vehicle Identification Number (VIN):

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Question - Required - I appoint Children's of Alabama as my attorney-in-fact to process the commitment to purchase application(s) in my name for the purpose of creating the Children's of Alabama distinctive license plate category. By typing my name below, I am authorizing Children's of Alabama to submit this information to the State on my behalf.

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Question - Required - I authorize the release of my name, address, and email address to the sponsoring organization of a distinctive license plate.

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Question - Required - By typing my name below, I certify that the information listed above is true and correct. I own/lease the vehicle described.