To purchase your "Stop Heart Disease" license plate, complete the following form. We will submit your data to the Pinellas County Tax Collector's office. They will contact you within the next business day to complete your purchase and will mail your license plate.   Contact Info   Name: Daytime Phone (with area code):  Home Phone (with area code): E-mail address: Current license plate #: Insurance Information   Insurance Company Name: Florida Policy #: 5-Digit # (located on your insurance card):