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Information Request Form for
AMSOIL Products or Product Applications

If you have questions or comments, you can submit them via this online form or contact us by phone at 570-470-3245 anytime. A representative will contact you via your preferred contact method as soon as possible.

Personal contact information will only be used to provide requested information or
assistance. You will not be enrolled in advertising or marketing programs and your
information will not be shared or sold.

*Required Fields                  *Name: 

 Business Name: 

*Email Address: 

*Street Address: 



*Postal Code: 

Phone Number: 

Contact me by: 

  Phone     Email

  I would like more information about:

Preferred Customer Membership:
"Save 25% on all purchases"

Becoming an AMSOIL Dealer:
"Start your own home business"
Retail Account
"Selling AMSOIL products in my store or service center"
Commercial Account
"Using AMSOIL products in my business vehicles"

 I need stock numbers for: 

 EA Oil Filter  EA Air Filter:

 Year:   Make:   Model:

 Engine Size:   2WD   4WD   Transmission: Auto   Manual

If you have product application questions or need more information about a product, please enter your questions or comments here:


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