PHA Plaque Order Form

[TKnorr]

PHA YEARLY PLAQUE ORDER FORM

In ordering, provide the following info:


Driver’s Name: ____________________________________ (print clearly)

Class: ___________________________________________ (print clearly)


7” X 9” Plaque, space for 4 event plates ………………………….. $15.37 (includes tax)

OR

10 ½” X 13” Plaque, space for 9 event plates + year end plate ……… $29.68 (includes tax)

Send this form with check or money order

Terre Trophy Co.
965 New Holland Rd.
Reading, PA 19607