AMC DISTRIBUTING, INC.    

P.O. BOX 520921  LONGWOOD,FL 32752-0921

          

Phone:407-521-9930  Fax:407 521-9097       Email: amcdist@earthlink.net

Toll Free1-877-426-2347
ORDER FORM
               

First time buyers: (Check Here)_____

Delivery address (Check one:                                                Business _____          Residential____

Sold to:

Ship to: (If different)

Business name:

_________________________________________

Name:_______________________________

Owners name:

__________________________________________

Address:_______________________________

Address:

_________________________________________

City:_________________________________

City:________________ State:______Zip:_______

State:__________Zip:___________________

 

                

Terms (Circle One)

      

Open terms: Subject to credit Check (Call)

Credit card

Money order

Company Check

Personal Check (Held until Cleared)

Florida Customers must Mail or Fax ReSale Certificate 
We do not ship C.O.D.

Phone:(       )         -     

Visa

MasterCard

      

Fax:    (       )         -

Credit card #

Exp:

Email:

Cardholder's Name:

Cardholder's Signature:

Referred by:
Initial Order: $250.00 Minimum  Re-Orders: 100.00 Minimum Handling charges: $6.95
(Continental U.S.)  Handling charges: International orders (including Alaska & Hawaii) $12.95
Shipping to be determined by Weight & Destination
Total will be E-mailed or Faxed for approval prior to shipping
QTY 

Page #

 Item# Description

Price Each
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         

Signature (required)____________________________________________

  

Fax form to: 407 521-9097