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:	School CEEB# (ETS, see section IV, 6 digits):: __ __ __ __ __ __
School Street Address:	Address:
City:	State:	Zip:
Teacher placing the order:

AMC 10-A	AMC 10-A Contest Bundles of ten	#_________ @ $ 12/bundle =	$
	Solutions Sets of ten (optional)	#_________ @ $ 6/set = $	$
AMC 12-A	AMC 12-A Contest Bundles of ten	#_________ @ $ 14/bundle =	$
	Solutions Sets of ten (optional)	#_________ @ $ 6/set = $	$
Postage/handling Fee (see chart below)			$
TOTAL			$
P.O. Number __________________
Visa, MasterCard, and American Express accepted. Cardholder’s home address required:
	- Card #:	Exp. Date:
	- Cardholder Name (please print):
	- Address:

MAA AMC PUBLICATIONS ORDERING -- TERMS Minimum order $10 (not including postage and handling) is required. Do not include Registration order. VISA, MasterCard and American Express accepted. Make checks payable to: American Mathematics Competitions PAYMENT IN U.S. FUNDS ONLY. U.S.A.: Order Total Shipping Charge $10.00 -- $30.00 $5.00 $30.01 -- $40.00 $7.00 $40.01 -- $50.00 $9.00 $50.01 -- $75.00 $12.00 $75.01 -- UP $15.00 CANADIAN: Same as above. Order will be sent by air mail. INTERNATIONAL ORDERS: DO NOT PRE-PAY -- A PROFORMA INVOICE WILL BE SENT TO YOU INCLUDING POSTAGE AND HANDLING FEES. Unpaid Purchase Orders will be accepted. There will be a $5.00 billing fee and postage charge added to the order. Prices good until September 1, 2002.<br> FAX 402-472-6087 or 1-800-527-3690 Please Send Your Order for Publications To: MAA American Mathematics Competitions ATTN: AMC 8/10/12 Publications P.O. Box 81606 Lincoln, NE 68501-1606

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.
Name of Person Authorized to Pay (please print): _______________________________________________________
Signature: ______________________________________________________________________________________
Title: ________________________________________	Date: ________________