Seneca Pure Waters Dock Plate Order Form

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Thank you in advance for supporting the PURE WATERS mission of preserving and protecting Seneca Lake. Your generosity will help ensure the lake is healthy for many generations to come. Enjoy your new Seneca Pure Waters Dock Plate! Dock Plates are $40.00, 8" x 15" in size, and customizable!

First & Last Name: *

Email: *

Phone: *

OPTION A: Dock Plate with Street Address:

OPTION B: Dock Plate with Last Name:

Which option of dock plate are you ordering today? *

Option A: Dock Plate with Street Address

Option B: Dock Plate with Last Name

If Option A: Write your Street Address as you would like it printed on the Dock Plate. Example: "2417 West Lake Rd"

If Option B: Write your NAME as you would like it printed on the Dock Plate. Ex: "The Fello's"

Shipping Address: *

Shipping City: *

Shipping State: *

Shipping Zip: *

You can pay for your dock plate by either credit card or check. If you plan to pay by check, please mail your check to the below address. If you are paying by credit card, please fill out ALL of the below billing information. Your order will be filled once payment is received.

MAIL CHECKS TO:
Finger Lakes Supply, Inc.,
P.O. Box 552,
Hammondsport, NY 14840

I will pay by:

Credit Card now

Check through the mail

Clear selection

Credit Card Number:

CC Expiration Date:

CC Security Code:

Billing Address:

Billing City:

Billing State:

Billing Zip:

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