Customer Information Form--AMG Publishers

Customers wanting to receive discounts when purchasing from AMG Publishers must complete the form at the bottom of this screen.

You may also dowload this form and fax it to our offices. Our fax number is (423) 648-2244. Click on the form provided on the screen to the right to dowload a PDF version of the "Customer Information Form" from AMG Publishers.

This download form is in a PDF (Adobe Acrobat) format. If you have Adobe Acrobat Reader installed on your computer, you should be able to view the attachment easily. If not, you may download the Adobe Acrobat Reader at the following website...click here or paste the following link into your URL browser:

http://www.adobe.com/products/acrobat/readstep2.html

If you have any questions regarding these forms, please contact our customer service department at sales@amgpublishers.com or call toll-free (800) 266-4977 (continental US & Canada) or (423) 894-6060 (international calls).

Thank you.

AMG Publishers

Customer Information Form--AMG Publishers

Customer Name
Bill to Address
City, State & Zip
Ship to Address (if different than bill to)
Ship to City,State, Zip (if different than bill to)
Years in Business
Business Telephone
Fax Number
Email Address (optional)
Authorized Buyer Name
Authorized Buyer Phone
Principal`s Name
Principal`s Title
EIN number
Resale/Tax Exempt Certificate number
Pay amount (optional)
Credit Card number (no hyphens--optional)
Expiration date--optional (month/year)
CCV1 Code--optional (3 digit number on back of card)
Name on Credit Card--optional
Billing Address for Card
City,State,Zip for Card
Electronic Signature (full name please)
Date Executed (month/day/year)
Please Enter Code Into the Textbox Below (code is case-sensitive):
This form is protected by 128-bit SSL encryption.

Customer hereby consents and agrees to all of the following terms and conditions:  The title and right of possession to all materials remain with the seller until the seller has received the full purchase price therefore in cash.  In the event of nonpayment, Customer agrees to pay all costs of collection, including agency fees, court costs, attorneys’ fees and other reasonable and necessary cost in an amount not less than 33 1/3 % of the unpaid principal and interest.  Credit will not be issued on goods returned unless returned with the prior consent of AMG. Customer agrees that any dispute regarding any of the transactions which may arise between it and AMG will be heard in the state or federal courts having jurisdiction in Hamilton County, Tennessee and the undersigned agrees to subject himself/herself and/or company to the personal jurisdiction of such courts.  The undersigned warrants that he/she is authorized to execute this application and to make this agreement for and on behalf of Customer, and by signing this application he/she also personally guarantees any indebtedness incurred by Customer.  Customer agrees that by completing the SIGNED line they electronically accepting the terms and conditions.

AMG PUBLISHERS does not store credit card information.  All credit card information will be destroyed.