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Mail To:

AMI Film Bin
48733 West Road
P.O. Box 930639
Wixom, MI 48393
Fax To: 1-800-944-2323

Always Include Your Customer ID Number For Quick Service
ID#______________________

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NAME:
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STREET:
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CITY:______________________––––––––__STATE:_______–––––––––––––__ZIP:
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DAYTIME PHONE:
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FAX:

Item Quantity Description Price Total Price
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An additional UPS $13.00 hazardous handling fee is required for each package of hazardous chemistry. MI Residents Add Sales Tax | ________________I
Shipping & Handling Fee | ________$7.95
UPS Hazardous Fee | ________________I
For C.O.D. Orders add $5.00 | ________________I
TOTAL | ________________I


Make Checks Payable To:
AMI Film Bin

Method Of Payment:

____Visa________ __MasterCard__ __Discover__ __Am Ex

____Money Order_ __Check ______ __C.O.D. (add $5.00)

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CREDIT CARD NUMBER_________________________________EXP.DATE (MO/YR)
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CUSTOMER SIGNATURE

 

 
 

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