AMD Request For License Application

Application Date *

Company Name *

Address

City

State select a state AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip

Telephone

Fax

Contact Person

Email Address *

Number of plant locations seeking certification or quality assurance services

Are the plant locations, in which final assembly of the product occurs, located within the continental United States? Yes No

If the answer to the above question is “NO”, please list the city and country in which final assembly of the product occurs.

Type of Products Seeking Certification For

Are you a new licensee and AMD member ? Yes No

Are you a New Licensee and not an AMD Member? Yes No

Are you an existing licensee and are adding a new program? Yes No

Fire Doors and Other Protective Openings Certification Program Yes No

Structural/Impact Certification Program Yes No

Manufactured Housing Certification Program Yes No

NFRC/Thermal Certification Program Yes No

Insulating Glass Certification Program Yes No

Quality Assurance Program Yes No