I understand that Amgraf, Inc. will verify the accuracy of this information by contacting the references listed above. I also certify that I have
read and understand the Amgraf, Inc. Void Pantograph End User License Agreement.
Your Name
Title
COMPANY
TELEPHONE
ADDRESS
APPLICATION DATE:
Amgraf's proprietary security technology is available only to reputable document producers who have a legitimate need to
manufacture secure documents for lawful customers. To protect against unauthorized usage of our technology, we perform
a background check before licenses are granted. The undersigned guarantees that the information below is correct and
complete and authorizes Amgraf to conduct any background investigation needed for verification of such.
Name of Business
Sole
Partnership
Corporation
Products and/or Services Produced at this Location
Street Address
City
Zip/Postal
Billing Address (If Different)
Telephone
FAX #
Name of Chief Executive Officer
Telephone
Name of Pre-Press Department Manager
Please explain what security technology you need, how it will be used, and what safeguards you will follow to keep the
technology from being misused, pirated, lost, or stolen.
Optional: List suppliers with whom you have maintained a business relationship for a minimum of one year.
Date Business Started
APPLICATION TO LICENSE AMGRAF SECURITY TECHNOLOGY
Extension
Zip/Postal
Telephone
Extension
Web Site Address
ASSOCIATION NAME
ADDRESS
TELEPHONE
Optional: List trade associations that your company is affiliated with.
Rest assured, we do not sell your nonpublic personal information to others.
Amgraf will contact you with your login and password as soon as we complete the Registration process.
State
City
State
E-Mail Address
All Yellow Fields are Required
Re-Enter E-Mail Address