AMP Secure Order Form

• All books in stock are shipped the same day that the order is received. In the continental United States books may take up to 2 weeks for delivery.
• Orders to Canada are shipped via airmail for $25.00 for first copy, $15.00 for each additional copy.
• All prices are subject to change.
• Please note that books may not all be received in the same package if an order is from sources other than AMP publications.
• Please note that no books are returnable under any circumstances.

You can order online or you can mail, fax, or phone this order form to:

Advanced Medical Publishing, Inc.
P.O. Box 5046
Madison, WI 53705
USA
Phone 608-833-2599
Fax 608-833-2255

Online Ordering Instructions : Please complete this form and press the Send Order button at the bottom of this form. Or call us at 608-833-2599 or fax your information to 608-833-2255.

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Current Order
ID	Description	Quantity	Price
The current order is empty.

I am a Wisconsin Resident   WI residents pay 5.5% sales tax.

Do you have any special instructions? (If you are using a purchase order, enter it here)

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Customer Information  (Required fields in Blue)

Name:
Organization:
Address1:
Address2:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
FAX:
Email:	Enter your email address if you would like an email confirmation of your order.

	   
Business Type:
 Radiation Oncologist
 Diagnostic Radiologist
 Medical Physics/Diagnostic
 Medical Physics/Therapy
 Dosimetrist
 Radiation Therapist
 Medical Oncologist
 Pharmacist
 Medical Oncology Nursing
 Radiation Oncology Nursing
 Manufacturer
 Institution

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Payment Information

Please fill out your credit card information below:
NOTE: If you are paying by Purchase Order you should print out this page and FAX it to (608) 833-2255.

Card Name:	SELECT CARD TYPEMasterCardVisaAmerican ExpressDiscover Card
Credit Card #:
Expiration Date:
Name on the Card:

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If you have a Promotion Code, please enter it here:

When you press the Send Order button, your information will be sent to us.

Thank you for your order!