AGS Fuel Vaporizer
P O BOX 1699
Riverton, Wyoming 82501
(888) 436-0899 * eFax (206) 666-3954
DISTRIBUTOR
PURCHASE
FORM
As a distributor of the AGS Fuel Vaporizer. I understand that I am fully authorized to purchase
product on a quantity basis. This will be based on the dealership agreement form I signed and dated, to
begin my dealership in my area. So long as I recognize that the rules and guidelines set forth in the regular
Dealership Application applies fully. In every detail to each and every unit that I obtain through
quantity, basically that is, that the product prepaid once received. All product is warranteed for 45 days
for defects only via the date stamped below. Dealer is responsible for freight damage reported for claims with shipping company.
I further understand that the cost of each unit purchased as a distributor (unless otherwise notified)
shall be as agreed upon via the agreement form, for all materials involved. Which must be prepaid at the time
of the respective order made before construction for shipping.
Having fully understood the foregoing statements, I the undersigned do hereby agree that when I set forth my
signature on this Dealership Order Form, that I fully agree with these terms, and shall abide by them
on each and every order made:
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I, The Undersigned Do Hereby Express My Desire
To Purchase _______ Fuel Vaporizer 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 Fuel Vaporizer
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:_______
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To Our Authorized Dealer,
When you order, please fill out this Purchase Form and mail it to us at the address above along with your payment made.
All other orders not purchased via Postal Money Orders, are subjected to bank clearance before we acquire the neccesary
materials for production and, construction of product started and completed, before preparation for shipment is made.
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 (Fuel Vaporizer) 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 several single purchases, email
Customer Service.
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