Amsoil Retail accounts are designed for businesses which operate from a storefront location (such as garage stations, lube shops, hardware stores, repair shops, etc.) and will be selling Amsoil products to their customers. As you purchase the Amsoil products, we will also generate ‘advertising credits’ for you, which will be used to send you promotional items for your personal and business use.

Upon approval of your Amsoil Retail Account application, you will have access to the full Amsoil product line at wholesale prices.

Setting up your Amsoil Direct order account is quick and easy. Just fill in the information below and within 24 hours, I will be contacting you with your Account Number and ordering information. Your Amsoil orders will be shipped directly to your from the Amsoil distribution warehouse closest to your business delivery address.

Note: Fields with a * are required.

First name:	*
Last Name:	*
Business name:	*
Mailing address:	*
City:	*
State/Province:	Alberta British Columbia Manitoba New Brunswick Newfoundlan Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ------ ------ Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Virgin Islands American Samoa Guam  *
Zip/Postal Code:	*
(Optional - only if different than mailing address)
Delivery address:
Delivery City:
Delivery State/Province:	Alberta British Columbia Manitoba New Brunswick Newfoundlan Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ------ ------ Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Virgin Islands American Samoa Guam
Delivery Zip/Postal Code:
Phone number:	*
Fax number:
Toll free number:
E-mail address:
Website address:
Owner/Manager first name:	*
Owner/Manager last name:	*
Purchasing contact first name:	*
Purchasing contact last name:	*
Accounts/Payable contact first name:
Accounts/Payable contact last name:
Number of retails outlets owned:	*
Type of business:	Quick Lube Center Auto/Heavy Duty Service Center Convenience Store Auto Parts Store Hardware Store Lawn & Garden Center Auto Dealership Mobile Oil Change Rental Outlet Recreational Vehicle Dealer(Motorcycle) Recreational Vehicle Dealer(ATVs) Recreational Vehicle Dealer(Snowmobiles) Recreational Vehicle Dealer(Marine) Recreational Vehicle Dealer(Campers) Farm-Ranch Implaments OTHER  *