Become a Registered Dealer
COMPANY INFORMATION
Company type Corporate Partnership Sole Proprietor
BILLING INFORMATION
SIGNATURE
MUST BE SIGNED BY AN OWNER PARTNER PRINCIPAL OFFICER OR DESIGNATED SIGNEE
if you are attaching you own company application form, it must also be signed for collection agreement.
I am authorized to complete this application and certify the above information is true compete to the best of my knowledge .
I authorized our bank and vendor to release information needed for the purpose of establishing credit worthiness. It is agreed
that if credit is granted, the method of payment will be met according to the terms on the invoices.
TRADE REFERENCE
Reference 1
Reference 2
*Add your current Tire supplier reference
Bank Reference (optional)