Sign Up To Be A Wholesale Tire Dealer with Future Tire

Company Information

Company Name * :

Doing Business As

Years in Business

Street Address:

City:

State:

Zip Code:

Phone Number * :

Fax Number:

Resale #:

Fed ID #:

E-mail Address * :

Website Link:

Type of Business

Principle Information

Principle Name:

Social Security #:

Phone Number:

Home Address:

State:

Zip Code:

Bank Information

Bank Name:

Account #:

Phone Number:

Bank Address:

State:

Zip Code:

Credit Card Authorization Form

Please complete all fields. You may cancel this authorization at any time by contacting us.This authorization will remain in effect until cancelled.

Credit Card Information

Card Type: MasterCard VISA Discover AMEX

Cardholder Name (as shown on card):

Card Number:

Expiration Date (mm/yy):

CVV Code:

Cardholder ZIP Code (from credit card billing address):

Business Name:

Account Number:

I, , authorize Future Tire to charge the credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.

COD Purchases which will be charged the day of delivery or pickup of merchandise.

On Account Purchases which will be charged on the 10 th day of the month due.

Customer Signature:

Date:

References

Reference #1 Name:

Reference #1 Address:

Reference #1 Phone #:

Reference #2 Name:

Reference #2 Address:

Reference #2 Phone#:

Reference #3 Name:

Reference #3 Address:

Reference #3 Phone#:

Online Setup

Would you like to be set up with an online account?
Online access allows you to check prices, inventory, and place orders online.
Yes

Username:

Password:

How Did You Hear About Us?

Terms & Conditions - Read Before Continuing!

PLEASE FILL IN THE ABOVE IN ITS ENTIRETY & READ THE FOLLWING CAREFULLY AND CLICK AGREE WHEN DONE.

It is hereby agreed to, by the undersigned, that all purchases from Future Tire Co., Ltd. Are due and fully payable by the 10th of the month (unless otherwise indicated on the invoice). The undersigned also agrees to any late charges for overdue balances at the rate of 1.5% per month (18% per annum). The undersigned hereby accepts full liability for any collection fees, legal costs and attorney fees, inclusively, deemed necessary to secure payment of any overdue monies. I acknowledge that Future Tire Co., Ltd. Has provided me with notice attached hereto, and make a part hereof, of my rights under the Federal Truth in Lending Act. The undersigned does personally guarantee full payment of all debts incurred in the name of the business and hereby binds himself to all terms of this agreement both individually and severally with the business.

Please enter your name as your online signature * :

I-Agree I have read the terms above and agree to the conditions stated. *

Verification Code *

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