Customer Credit

Customer Credit Form

Fill out the form below with your information if you are interested in working with us.

IMPORTANT: FORM MUST BE FILLED OUT COMPLETELY FOR RAPID CREDIT APPROVAL

Company Legal Name:

DBA:

Address:

Federal Tax ID:

City/State/Zip:

Phone:

Fax:

Type of Business:

Email:

Resale Tax No:

(Include Tax Exemption Certificate if purchasing for resale, otherwise Sales Tax will be charged.)

Corporation Partnership Proprietorship

Year Established:

Credit Line Requested:

Gross Sales:

Name of Principal/Owner:

Email:

Cell Phone:

Name of Purchasing Manager:

Email:

Cell Phone:

Name of Warehouse Manager:

Email:

Cell Phone:

Name of Finance Manager:

Email:

Cell Phone:

Trade Reference 1

Address

Phone

E-mail

CONTACT

Trade Reference 2

Address

Phone

E-mail

CONTACT

Trade Reference 3

Address

Phone

E-mail

CONTACT

Trade Reference 4

Address

E-mail

Phone

CONTACT

Bank Name

Account Number(s)

Address

Bank Contact

E-mail

Phone

Owner's/Officer's Name

Home Address

City/State

ZIP

Home Telephone

Drivers Lic. No.

Upload Drivers License

Social Security No.

Please download and sign the Applicant's Signature form below. Upload document here to complete application.

TDU Tire is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, please tick below to say how you would like us to contact you

Customer Credit Form

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