Application for Account : Tire Rack Fleet

Please enter information in all fields noted in red below.

Contact Information

Name of Business:
Doing Business As Name:
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:	I would like to receive email from Tire Rack Fleet's credit department regarding my account when required. Yes No
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 years under current ownership:

Number of locations:

Do you currently have an account with Tire Rack?

Yes No

Can you meet a 20 tire order to qualify for the best pricing tier?

Yes No

Type of business:
Describe your type of business.

Is your business a:

Sole Proprietorship Partnership

Corporation LLC Municipality

Legal 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:

Fleet Account Payment Options

Approval is based on credit history and reference responses.

Please select the type of account you would prefer.

Credit Card:
Pay at the time of order and card "must be present" to pick up at our distribution centers.
a) Card issued in company or owner name.
b) References are not required for credit card accounts.
Open Account:
All invoices dated prior to the end of given month are due on the 10^th day of the following month by preferred payment of EFT/ACH or company check.

a) Requires a satisfactory payment history with current vendors. b) Monthly credit line your company is seeking $ to be considered at time of approval. c) e-Statement: Upon approval, I am interested in receiving my statement via email.

References

References are NOT required for credit card applicants.

Please list three major business credit references that are not financially linked to or otherwise supporting your business.
Fax numbers, email addresses and vendor account numbers are helpful.

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

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

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

After submitting this application, your new Fleet account will normally be ready to place an order the same day using a company or owner credit card.
Approval for open terms may take 1-2 weeks for processing. It is based on the response time from the references that are provided above.
Password Protection is available. Contact the Credit Department to sign up following the approval of your account.

Please select 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 866-580-5523 or email to creditapplicationfleet@tirerack.com.
Your fleet application will not be processed without it.
If your organization is tax exempt, submit your exemption form here.

To contact us regarding the status of this application, please email creditapplicationfleet@tirerack.com or call the Credit Department at 866-566-5140, ext. 4350.

The applicant hereby authorizes Tire Rack, any credit bureau, or any other investigative agency employees to contact the references given herein and to investigate any statements or other data obtained from applicant or any other person pertaining to the applicant's credit and financial responsibility. If outside intervention is required to collect payment, the applicant agrees to pay all fees incurred by Tire Rack for such outside assistance, including but not limited to attorneys' and collection agency fees. The applicant hereby authorizes Tire Rack to contact applicant by email with respect to matters involving applicant's account, including the collection of any amounts owed to Tire Rack. Yes

Name:	First Name Last Name
Title:
Date:

Application for Fleet Account