AGS Fax Order Form

AGS Fax Order Form FAX 541-336-2427 PHONE 541-336-2426
Minimum order $50.00
Discount per delivery per part number 1-99 base price, 100-249 -2%, 250-499 -5%, 500-999 -7%, 1000+ -10%
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

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

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:

__________________________________________