Tire Discounters

Please fill out the form to begin scheduling an appointment. A member from the store will contact you to get your appointment set up and to be sure we have the correct details.

Select Preferred Store:

Customer Information

First Name*

Last Name*

Address 1*

Address 2

City*

State*

Zip*

Drop-Off Address

Drop Off Address 1*

Drop Off Address 2

Drop Off City*

Drop Off State*

Drop Off Zip*

Mobile Service Address

Mobile Service Address 1*

Mobile Service Address 2

Mobile Service City*

Mobile Service State*

Mobile Service Zip*

Phone*

Email*

Send me text confirmation and reminder about my appointment
Standard text message rates may apply. Your mobile number will only be used to contact you about this purchase. You may opt out of receiving text messages at any time. Yes, please send me special deals and announcements by email.
You may opt out at any time. Yes, please send me special deals and announcements by text message.
Standard text message rates may apply. You may opt out of receiving text messages at any time.

Requested Services

Tires (New/Replace) Tire Repair Oil change Scheduled Maintenance Free safety inspection (brakes, battery, belts, and hoses, etc.) State inspections are separate. Auto Glass Repair or Replacement (Select stores) Other

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VEHICLE INFORMATION

Vehicle License Plate Number
I Don’t Have My License Plate Info

VEHICLE LICENSE PLATE*

VEHICLE LICENSE PLATE STATE*

VEHICLE YEAR*

VEHICLE MAKE*

Vehicle Model*

Vehicle Trim

Appointment Date & Time

Select Preferred Apppointment Date:

Select Preferred Appointment Time:

By clicking “Next”, you agree to receive the materials indicated by the completed checkboxes above.

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