Customer File Update

To service your account - timely and accurate information is critical, please take a moment to submit the following information if you have had any changes to your Special Instructions.

Name
Title
Company
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
Attention
Web Address
 

2.    How many tractors you have at this location?

3.    How many trailers do you have at this location?

4.    Do you require a Purchase Order? Yes  No

          IF YES, CHECK ALL THAT APPLY:

          FAX PO'S DAILY           BEFORE REPAIRS
          AFTER REPAIRS          WHEN BILLING INFORMATION
                                                         IS AVAILABLE
5.    Do you want to be notified about your breakdowns in the following 
       instances?
       PLEASE CHECK ALL THAT APPLY

        AS SOON AS THEY OCCUR   
        THAT EXCEED A TIME LIMIT OF HOURS
        ALL THAT EXCEED A COST OF DOLLARS
             
(THIS WILL BE OUR DOLLAR LIMIT ON REPAIRS WITHOUT AUTHORIZATION)
        WHEN THEY ARE COMPLETED
        OTHER: PLEASE LET US KNOW IF THERE ARE DIFFERENT OR SPECIAL
              INSTRUCTIONS THAT YOU WISH US TO FOLLOW.
             

6.    Who can we contact  to authorize repairs after hours and on weekends?
        NIGHT/WEEKENDS:
       NAME:  
       PHONE:
       MOBILE: PAGER:

        NAME:  
       PHONE: 
       MOBILE: PAGER:

        NAME:  
       PHONE: 
       MOBILE: PAGER:

7.    Please select any tire brands that your company has a national account for:
       (CHECK ALL THAT APPLY)

           BRIDGESTONE        GOODYEAR
        FIRESTONE     YOKOHAMA             KELLY
        GENERAL        KUHMO                    TOYO
        COOPER           DAYTON                  BANDAG

8.    What brand of tire do you prefer to be used when replacing tires on:

       STEER:  1st
                    2nd
                    3rd
                    4th
       DRIVE:   1st
                    2nd
                    3rd
                    4th
    TRAILER:  1st
                    2nd
                    3rd
                    4th

9.  Accounts payables contact:
     NAME  
     TITLE  
     PHONE
     FAX     

10. Would you like any wallet cards or cab stickers?
      (These items are provided as part of your service and are free of charge)

       YES WALLET CARDS,
             HOW MANY  
       NO WALLET CARDS
       YES CAB STICKERS,  
             HOW MANY
       NO CAB STICKERS