Value Added Reseller | Referral Program Request Form

Please complete the short form below to receive additional information about the AMS Value Added Reseller program or the Easy AMS Referral program.

Full Name*
Title
Company/Practice*
Specialty
Email*
Phone*
Address*
Street Address City State ZIP / Postal Code
Website
Please check all that apply:
- I am interested in the AMS Value Added Reseller (VAR) program.
- I am interested in the Easy AMS Referral program.
Please feel free to give a brief description as to why you are interested in either or both of the programs listed.

Mailing Address

American Medical Software
1180 South State Route 157
Edwardsville, IL 62025

Phone & Fax

Phone: 800-423-8836
Fax: 618-692-1809

ams-building

American Medical Software company headquarters located in Edwardsville, Illinois.