AGS Fax Order Form FAX 541-336-2427 PHONE 541-336-2426
Minimum order $50.00


sales@ags.bz    engineering@ags.bz    PLEASE DO NOT EMAIL YOUR CREDIT CARD INFORMATION.

FILL IN THIS FORM AND PRINT THEN FAX TO 541-336-2427   or  
Part Number Quantity
Ordered By  Ref P.O. #
Company Quoted Price
Mail Address
Ship Address State
City Zip
Phone Number   Extension
Fax Number
E-Mail Address:
Credit Card
VISA      MC      Discovery      Amex 
Expiration Date
Number Security Code
Name on Card
UPS Acct. #
FedEx Acct. #
Ship Via UPS Ground         UPS 3 Day   Add to Invoice  
UPS 2 Day           UPS Overnight  
FedEx Ground     FedEx Overnight
Required before processing    I agree to AGS conditions and Terms of Sale   Conditions and Terms of Sale.
Signature:

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