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