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
First/Last Name:    
Phone:    xxx-xxx-xxxxd colspan="2">
Today's Date:   6/19/2018
Please Enter Text: