1st AGS Distributorships form for the Fuel Atomizer 2000

AGS Online Fuel Atomizer

DISTRIBUTOR MEMBERSHIP PURCHASE FORM

      As a distributor of the Auto Super Club with AGS Online , I understand that I am fully authorized to purchase memberships on a quantity basis , without filling out a regular Membership Application for each and every membership that I obtain, so long as I recognize that the rules and guidelines set forth in the regular Membership Application applies fully and in every detail to each and every membership that I obtain even though they are in quantity form, and basically that is, that the membership is a purchase, and a Fuel Atomizer 2000 is a Free Gift which accompanies each and every membership purchased.
      I further understand that the cost of each membership is , (unless otherwise notified) shall be as stated elsewhere in the Distributorship Agreement, Shipping & Handling, for all materials involved, which shall be paid at the time of the purchase, unless otherwise agreed to in writing, and includes a Fuel Atomizer 2000 with each membership purchased as my Free Gift.
      Having fully understood the foregoing statements, I the undersigned do hereby agree that when I set forth my signature on this Membership Purchase Form, that I fully agree with these terms, and shall abide by them on each and every membership purchased.

I, The Undersigned Do Hereby Express My Desire

To Purchase The Sum Of _______ Memberships

I am submitting $_____________ in the form of a:

__ Check or Money Order Enclosed.         __ Charge to my VISA/Mastercard/Am.Express/Discover or Debit Card (visa-m/c).

____________________         _________________          ___________________
       Account Number                         Expiration Date              Signature of Cardholder

Distributor's Number:______________________

___________________________________          _______________
    Distributor's Signature                                            Date
Dear Distributor,
      When ordering memberships, please fill out this Purchase Form, and mail it to us along with your check or money order made payable to AGS International (or you may fax it to us if using a credit card). (If membership Fee is paid by personal check, do not expect delivery of materials until check has cleared your bank.)
IMPORTANT NOTE: Each membership purchase must be accompanied by a Membership Purchase Form, otherwise a 2nd membership purchase will not be honored. The warranty is void for each and every membership ordered in quantity without a signed form.

IF THE FREE GIFT HAS BEEN TAMPERED WITH - SUCH AS DISMANTLED IN FULL OR IN PART, OR CHANGED IN ANY WAY, THE GUARANTEE IS IMMEDIATELY VOID.

Please print this form, fill it out, and mail it in to : AGS Online - P.O. Box 351 - Riverton , Wyoming 82501 - or fax it to 1-208-692-3632 . Click on your "print button" on your browser and download . Or you can call 001-307-856-5484 - 8am to 5pm - Monday thru Friday - M.S.T.