Application for Account : Tire Rack Fleet

Please enter information in all fields noted in red below.

Contact Information

Name of Business:
Billing Address:
City:
State/Province:
ZIP/Postal Code:	Different Shipping Address

Shipping Address:
City:
State/Province:
ZIP/Postal Code:

Phone:(Including Area Code)	If your telephone number is not listed with Directory Assistance, please provide a copy of your phone bill showing the phone number and business address.
FAX:
Cell Number:
Email Address:	I would like to receive Tire Rack Fleet's email newsletter featuring the newest products as well as helpful tips on using this website. Yes No
Website URL:(If applicable)
Account Payable Contact Name:
Name:	First Name Last Name
Email Address:
Whom would you like us to contact with questions on this application?
Name:	First Name Last Name
Phone:(Including Area Code)
Email Address:

Business Information

How many vehicles are in your fleet?
How many tires do you project purchasing monthly?
How long have you been in business?
Number of locations:
Type of business: Describe your type of business.
Is your business a:	Sole Proprietorship Partnership Corporation
Name of owner(s) or corporate officer(s):
Name:	First Name Last Name
Title:
Name:	First Name Last Name
Title:
Name:	First Name Last Name
Title:
Do you currently have an account with Tire Rack Wholesale? Yes No If yes, Account #:

Bank Information

Bank Name:
Address:
City:
State/Province:
ZIP/Postal Code:
Phone:(Including Area Code)
Contact Name:	First Name Last Name

Fleet Account Payment Options

Approval is based on credit history and preference responses.

Please select the type of account you would prefer.

COD Account (Certified Check):
a) Pay with U.S. postal money order or cachier's check upon delivery.
b) Orders may require a deposit. Company business credit cards are acceptable for deposit.
COD Company Check Account:
(UPS will accept your company check.)
a) Requires that your company has been in business for a minimum of one year.
b) Requires a clean credit history and no NSF checks.
Open Account:
All invoices dated prior to the end of any given month are due on the 10^th day of the following month.
a) Requires an excellent credit history.
b) Requires significant credit line with current suppliers.

References

Please list three major auto-related suppliers or credit references. Fax numbers MUST be supplied.

Business Name:
Address:
City:
State/Province:
ZIP/Postal Code:
Contact Name:	First Name Last Name
Phone:(Including Area Code)
FAX:
Email Address:

Business Name:
Address:
City:
State/Province:
ZIP/Postal Code:
Contact Name:	First Name Last Name
Phone:(Including Area Code)
FAX:
Email Address:

Business Name:
Address:
City:
State/Province:
ZIP/Postal Code:
Contact Name:	First Name Last Name
Phone:(Including Area Code)
FAX:
Email Address:

It typically takes 1 to 2 weeks to process this application, however it depends on the completeness of this application and response time from the references you listed.

Password Protection is available. Contact the Credit Department to sign up following the approval of your wholesale account.

To contact us regarding the status of this application, please or call Jocelyn at 866-566-5140, ext 217.

Please enter the name and extension of the sales specialist you spoke with regarding this application.

A copy of your business license is REQUIRED. Please fax to 574-236-7704, Attn. Jocelyn. Your fleet application will not be processed without it.

I hereby authorize the company to whom this application is made, any credit bureau, or other investigative agency employees to investigate the references herein given and any statements or other data obtained from me or any other person pertaining to the company's credit and financial responsibility. In the circumstance that outside intervention is required to collect payment, I agree to pay any additional fees resulting from such collection activities. Yes

Name:	First Name Last Name
Title:
Date:

Application for Fleet Account