PLEASE Print this form, then FAX OR MAIL TO:

AMR Powersports Inc.

18735 County Rd. 18

Martintown, Ontario K0C 1S0

Fax: 613-249-0770

Disclaimer:

Note to credit card purchases: Your signature is required on this form prior to being faxed in and constitutes your acceptance of future charges against your credit card for orders placed by you with AMR Powersports Inc.

The only information stored on this Website is your Customer #, email address and secured password. All other relevant personal information is kept on file at our Head Office only so there is no information available on this site to be hacked.

An email will be sent to you requiring your confirmation every time you place an order. This is to ensure you are the one who placed the order and allows you to confirm the items ordered along with the final invoice amount that will be charged to your credit card. Your credit card will only be billed once your order is ready to ship.

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Payment Options:

Credit Card Information:

Please debit my Credit Card for all Future Purchases: _______ Visa _______ Mastercard _______ Card # ____________________________ Expiry Date: _______ Cardholder Signature: __________________________________ Print Name: __________________________________

- OR -

Money Orders:

I prefer to send in a money order: _______ I understand that my order will not be processed until AMR Powersports Inc. has recieved my money order by mail!! Signature: __________________________________ Print Name: __________________________________