Tire Discounters

Contact Details:

Applicant First Name*

Applicant Last Name*

Applicant Phone Number*

Applicant Email*

Company Information:

Company Name*

Company Phone Number*

Type of Company*

Number of Locations*

Number of Fleet Vehicles*

What service areas are your vehicles located? (City, State)*

WERE YOU REFERRED BY A LOCAL STORE? (Select One)

Business Address*

Business City*

Business State*

Please Choose a State

Business Zip Code*

Different Billing Address?

YES

NO

Billing Address*

Billing City*

Billing State*

Please Choose a State

Billing Zip Code*

Additional Contacts:

Fleet Manager First Name*

Fleet Manager Last Name*

Fleet Manager Email*

Give online access

Accounts Payable Contact First Name*

Accounts Payable Contact Last Name*

Accounts Payable Contact Email*

Give online access

AUTHORIZATION REQUIREMENTS:

Information requested on invoice (check all that apply):

Tax ID*

Years in Business*

Tax Exempt (If yes, we need to receive a COPY of your tax exemption certificate)

Account Restrictions/Notes*

CREDIT APPLICATION:

Would you like to apply for credit in order to set up a billed account?

Make fleet service easy for you and your team with convenient Tire Discounters Credit. Simply fill out the Trade References and Tire Discounters will send you a monthly invoice formatted with the information you request.

YES

NO

Three references required for billed account, N/A for cash accounts.

Please list vendors who extend open credit to your company. Do not list financial institutions.

Trade Company Name (1)*

Trade Account Number (1)*

Trade Phone (1)*

Trade Company Name (2)*

Trade Account Number (2)*

Trade Phone (2)*

Trade Company Name (3)*

Trade Account Number (3)*

Trade Phone (3)*

Tire Discounters' acceptance of this Fleet Service Application does not require you to have your vehicles serviced at a Tire Discounters store; however, it does authorize Tire Discounters to service your fleet vehicles pursuant to the Tire Discounters, Inc. Fleet Credit Account Terms and Conditions (the “Terms and Conditions”) found here. By providing your initials below, you are signing this Fleet Service Application and represent that you have the authority to sign the Fleet Service Application on behalf of the Company listed above and expressly acknowledge acceptance of the Terms and Conditions, as may be amended from time to time in Tire Discounters' sole discretion.

Invoices will be delivered via email at the email address provided above, unless otherwise requested. All charges are due thirty (30) days after Invoice date. Payment shall be made to the address listed on the Invoice. Monthly statements may be sent as a courtesy.

Legal Terms and Conditions

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