Specialty License Plate Voucher Request - A Safe Haven for Newborns

To Order your SHFNB Specialty License Plate Instructions:

Complete the Specialty License Plate Voucher request form in section A and Section B
For Credit Card payment submit payment of $34.03 ($33 + $1.03 for credit card processing fee)
To pay by Check mail a check for $33 to A Safe Haven for Newborns
We will send your Specialty License Plate form and payment to the Tax Collectors office. Upon meeting the pre-sale quota of 3,000 vouchers, they will send you the voucher for you to exchange for the specialty license plate.
A Safe Haven for Newborns will notify you by email when we have reached the 3,000 voucher quota and when your Specialty license plate will be available.
Take the voucher to your nearest license tag office to receive your new A Safe Haven for Newborns specialty tag. The tag will be available at all vehicle registration offices across the state.

Thank you so much for helping to create greater awareness to this life-saving program.

Purchaser’s Name (Complete name as it appears on the motor vehicle registration):(Required)

First Last

Purchaser’s Florida Driver License number OR Date of Birth OR License Plate Number:(Required)

Purchaser’s Email:(Required)

Receiving Customer’s Name (Complete name as it appears on the motor vehicle registration):(Required)

First Last

Receiving Customer’s Florida Driver License number OR Date of Birth OR License Plate Number:(Required)

Receiving Customer’s Emails:(Required)

Safe Haven for Newborns License Plate Voucher:(Required)

Price:

Credit Card Fee:(Required)

Price:

Total

Payment

Pay by Credit Card

Pay by Check

Credit Card

Card Details

Cardholder Name

Please make your check or money order payable to: A Safe Haven for Newborns

MAIL TO:

Gloria M. Silverio Foundation
“A Safe Haven for Newborns”,
6955 NW 77th Avenue, Suite #302
Miami, Florida 33166

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