Product Sample Registration Form with Free T-Shirt

Fill Out the Information Shown Below and
Your T-Shirt Will be Sent to the Address Provided.

To Qualify You Must Register Your Sample Upon Its Receipt

Please Register The Sample I Received and Send My T-Shirt As Follows:

Your Name (required)

Your Title or Position (required)

Your Email (required)

Company Name (required):

Current CustomerHave Used on ProjectsKnow About, But Never UsedNew to American FittingsNever Heard of You

Our Company Is: (required) (use pulldown menu highlight selection and hit enter key)

Address to Send T-Shirt To: (required):

City (required):
State (required):

Zip Code (required):

Telephone (required): (Please format (xxx)-555-1212)

Select T-Shirt Size:

The Purpose I Requested the Sample (required): (Highlight & Hold Ctrl Key and Click on All That Apply)

Please Add My Name for Future Product Promotions and Offers:

Need Another Sample, Pricing, or Any Additional Info, Type in this Box.

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Please Allow 2 Weeks for Your T-Shirt to Arrive.

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t: 800-221-5268   |   f: 201-664-1175

17-10 Willow Street, Fair Lawn NJ 07410

e: info @ amftgs . com

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