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DATE: __________________________                

NAME TAG ORDER FORM

FOR THE

TAX COLLECTORS’ ASSOCIATION OF CONNECTICUT

 FOR MUNICIPAL OFFICIALS ONLY!!!

The cost of a new name tag is $15.00.  Please complete this order form and return it, along with your check made payable to the Connecticut Tax Collectors’ Association, Inc. to:  

Maeci Evans, Asst. Treasurer                         Phone:  (203) 256-3103
c/o Fairfield Tax Office                                     Fax:      (203) 254-4803
611 Old Post Road                                          Email: mevans@town.fairfield.ct.us
Fairfield, Connecticut  06824 

You can also download this form off our website: www.cttax.org - click on Order a CTX Name Tag

Name:  ____________________________________      CCMC:      Yes   or   No 

Name of Municipality: _____________________________    (BLUE NAME TAG)

                                      (City/Town/Fire District/Sewer District) 

Name of Company: _______________________________ (WHITE NAME TAG)

                                     (for vendors/associates) 

Please circle if applies:    Board Position:      ____________________________

                                            Retiree                                      

Cost of name tag is:        PAID     Check#:                           Cash: 

          UNPAID