AMC DISTRIBUTING,INC.
6229 EDGEWATER DRIVE, SUITE 200
ORLANDO, FL 32810
PHONE:407-521-9930					F AX: 407-521-9097		TOLL FREE: 877- 4AMCDIS (426-2347)
					E-MAIL: amcdist@earthlink.net
NEW CUSTOMER APPLICATION
DATE:_____________________
	BILL TO:
NAME:    _____________________________________
CONTACT:_____________________________________
ADDRESS :    _________________________________________________
CITY:   _________________________				STATE:________		ZIP:_________________
PHONE:   ______________________				FAX:______________________________
E-MAIL:________________________________________
	SHIP TO:
NAME:    _____________________________________
CONTACT:_____________________________________
ADDRESS :    _________________________________________________
CITY:   _________________________				STATE:________		ZIP:_________________
PHONE:   ______________________				FAX:______________________________
KIND OF BUSINESS______________________________P.O. REQUIRED?   YES / NO
TERMS DESIRED
____ COD-CASH ONLY				________ VISA
_____ NET 30 DAYS				________ MASTERCARD
_____ CHECK W/ORDER
!!!! FLORIDA CUSTOMERS !!!!
	Florida customers must provide to us a "signed copy" of the current year's "Annual Resale Certificate". Please be sure it is signed and dated on the bottom right of the form. AMC Distributing, Inc., as a wholesaler, does not collect sales tax.
FAX TO:407-521-9097 OR MAIL TO: P.O. BOX 520921, LONGWOOD, FLORIDA 32752-0921
TAX EXEMPT#  ________________________________________
ACCOUNT OPENED BY:____________					ACCOUNT UPDATED ON ___________