9 PLEASE PRINT THIS INVOICE, COMPLETE THE FOLLOWING INFORMATION AND MAIL TO: DMB

 

 

Office of Regulatory Reform 2nd Floor, Mason Building 530 W. Allegan, Lansing

MI 48933                                                                                        

 

Make checks payable to: State of Michigan.                                       

 

Date:
Customer Phone
Customer Name
Mailing Address

 

Subscription                     Service from 1/15/2005 - 1/15/2006	Quantity	Unit Sub(s)	Unit Price $400.00	Amount
				Invoice Total