American Financial and Automotive Services, Inc.

Information Change Form

Recipient's ID #:

Make Changes Below

First Name:	*Please enter a First Name.
Last Name:	*Please enter a Last name.
Title:	*Please enter a Title.
Phone Number:
Ext:
DDM Name:	*Please select a DDM.
Dealer Number:	*This dealer number isn't eligible.
	Additional Dealer Numbers.
2nd
3rd
4th
5th

Email:	*Please enter an Email .
Dealer Email:	*Please enter a dealer email.
Home Address:	*Please enter an address.
City:	*Please enter a city.
State:	*Please select a state.
Zip:

The Recipient's ID Number must be written or typed in the "ID No." field to the right of your signature in the "Dealer Representative" field on every contract before being remitted to American Financial Warranty Corporation. All contracts remitted without a Recipient ID Number in this field will not be awarded MasterTech Rewards. Be sure to list all dealership account numbers you are associated with. Failure to do so could result in lost MasterTech Rewards.