AGS Atomizer
P  O     BOX  1699
Riverton, Wyoming   82501
(888) 436-0899 * eFax   (208) 692-3632
DISTRIBUTOR   PURCHASE   FORM
    As a distributor of the AGS Auto Club (in connection with AGS FA 2000). I understand that I am fully authorized to purchase product on a quantity basis. Without filling out a regular Club Member for each and every certificate that I obtain. So long as I recognize that the rules and guidelines set forth in the regular Application applies fully. And in every detail to each and every product that I obtain even though they are in quantity form. And basically that is, that the membership is a purchase, and a Atomizer (product) is part of the Gift which accompanies each and every kit purchased.
    I further understand that the cost of each (25 minimum) units as a distributor (unless otherwise notified) shall be {call for details} inside the U.S. Borders, for all materials involved. Which must be paid at the time of the purchase, unless otherwise agreed to in writing. And includes an Atomizer 2000 with each membership purchased as is.
    Having fully understood the foregoing statements, I the undersigned do hereby agree that when I set forth my signature on this Member 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 _______ FA 2000 kits as quoted
I am mailing in an order in the amount of $_____________


(Discount on PO Money Order’s Send only purchase price on each Unit less S&H;)
US Postal Money Order # ______________        Amount $_______.___
Make Payable and Mail to: AGS FA 2000
                                                PO Box 1699
                                                Riverton, Wyoming 82501
Distributor's (Associate)#:_______   {issued on order received}
        Distributor's Name (type or print clearly): ____________________________
Valid & Current Email: ____________________________                                    Today:                                       

Ship to:____________________________________      Tele: (       )          
City:___________________________   State/Province:________________________________   Zip:_______


Dear Associated Distributor,
    When you order, please fill out this Purchase Form and mail it to us at the address above along with your payment made. (If purchase is paid by personal check, do not expect order shipped until check has cleared your bank).
IMPORTANT NOTE:
    Each purchase after this must be accompanied by total number purchased on a note with your order, otherwise a 2nd purchase CAN NOT be honored till you contact us. The warranty is void for each and every unit in quantity if repair work is requested but found tampered with.
IF THE (ATOMIZER) product HAS BEEN TAMPERED WITH - SUCH AS DISMANTLED IN FULL OR IN PART, OR CHANGED IN ANY WAY, THE WARRANTY IS IMMEDIATELY VOID.
Quick order:
For a single purchase form email Customer Service. To place a small order {non dealer price}secure online click here, order will processed online, thank you.