Please fill in the information below and FAX your order. The administrator or authorized person of the school agrees to pay the American Mathematics Competitions for the following materials:

School Name		CEEB #
Address
City	State	Zip
Teacher placing the order
AMC 10 Contest A Bundles of ten #_________ @ $12/bundle = $ A Solutions Sets of ten (optional) #_________ @ $ 6/set = $
AMC 12 Contest A Bundles of ten #_________ @ $14/bundle = $ A Solutions Sets of ten (optional) #_________ @ $ 6/set = $
Postage/handling Fee (see chart below) $ Total $ P.O. Number Address: VISA/MC # : Name (Please Print): Exp. Date:
AMC ORDERING – TERMS 1. VISA, MasterCard and American Express accepted. FAX 402-472-6087 or 1-800-527-3690 2. Make checks payable to: American Mathematics Competitions Please Send Your Order To: American Mathematics Competitions ATTN: AMC 10/12 Additional Bundles P.O. Box 81606 Lincoln, NE 68501-1606 3. PAYMENT IN U.S. FUNDS ONLY. 4. U.S.A.: Order TOTAL Shipping Charge* $10.00 -- $40.00 $7.00 $40.01 -- $50.00 $9.00 $50.01 -- $75.00 $12.00 $75.01 -- UP $15.00 5. CANADIAN: Same as above. Order will be sent by DHL. * Orders after February 1st add $5.00 additional for 2-day UPS. Orders after February 5th add $10.00 additional for 1-day UPS.
Proof of Intent to Pay This document is intended to be used in lieu of pre-payment when calling or faxing in an order. Please indicate if you wish to be billed or will be sending a “check in the mail” (to be received within 2 weeks of order or you will be billed). Mail orders not wishing to be billed should include a check when returning this form. The person who signs this form must be authorized to pay the order that is placed by the teacher. BILLED Name of Person Authorized to Pay (please print): Signature: Title: Date: