Available HEAT® Apparel & Order Form
Complete and print the form.
Indicate quantity desired.
All prices include tax, shipping and handling.
If the item is not on the list,
e-mail us
and we'll try to accommodate you!
Please allow six weeks for delivery.
White Polo Shirts
View Polo Shirt
with embroidered HEAT® logo:
Small - $22.00
Medium - $22.00
Large - $22.00
XL - $22.00
XXL - $24.00
XXXL - $26.00
Hats/Visors
View Baseball Cap
HEAT® Baseball Cap - $10.00
HEAT® Visor - $10.00
Amount Due =
0
Amount of your check
Enclose a check made payable to the
Michigan Auto Insurance Placement Facility (MAIPF).
Mail to: MAIPF
Attn: HEAT - Wear
17456 Laurel Park Drive N., Suite 130E
Livonia, MI 48152-3981
Comments:
First/Last Name:
Organization:
Address:
City/State/Zip
Phone:
xxx-xxx-xxxxd colspan="2">
Today's Date:
6/18/2013
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