"Slot Machine Player Program Order Form ":


  • 1) Fill in your Credit or "online" card information for the purchase.
  • 2) Fill out your name and shipping address.
  • 3) Fill out exactly how many orders of this fine product/service you would like.
  • 4) Understand that there are “ no warrantees” with this order, just a delivery of the product & service being offered.
  • 5) We ask , but , its not neccessary to sign your order. Please understand that an order through computer is valid as well.
  • 6) Understand that we can ship to you via : fax, email, or mail order postally.

  • Please read & fill out below:
  • To order by Check : (your procedure order will be mailed at the reception of your check sent to our office).
  • Make your $35.00 Check or Money order payable to :
    AGS Casino Slot Program
    P.O. Box 351
    Riverton,Wyoming
    82501-0351

    __Check __Money Order
    Check# _______ Money order# _______________

  • Credit Card Orders below :

  • (Please check one) :__(Visa) __(M/C) __(Am.Exp.add 3%)
    •                 
       Credit Card # : _____/_____/_____/______      
       (Date Exp.): ____/____    Total programs ordered : ___
         Cardholder’s Signature : _____________________

  • Name : ____________________

  • Address : ____________________

  • Telephone: (___)___-_____
  • City : ____________

  • State/Prov. :__________

  • Email : __________________________ Fax#: (___) ___ - ______

  • Zip : __________


    •    Fax to us @ (208) 692-3632

    For online credit card purchases here > "Online"

    * To download this form , press the "print" button on your browser.    Go to the website to read about this program here.