Customer Fact Sheet

This form will be sent to the Credit Department for review.

Customer Name(Required)

Sales Representative Code & Name(Required)

Please enter your salesperson code and name

Warehouse / Profit Center(Required)

Please choose your warehouse/profit center

Credit Limit Request(Required)

Should be enough to cover 2 months worth of purchases.
*Enter Number Only*

Term Request(Required)

Payment Terms

Existing Suppliers(Required)

Payment Terms

Expected Monthly Volume(Required)

Expected GP(Required)

Gross profit percentage

Will We Provide Services/Labor?(Required)

Yes

Not Sure

Other

Type of Tires Sold(Required)

ATV/Turf

Farm

Forklift

Large OTR

PLT

Small OTR

TBR

Other

Are they Reselling Tires?(Required)

YES

PROVIDE THREE LEVELS OF CONTACTS

Buyer, Owner, Accounts Payable & Other

Buyer Name(Required)

Buyer Email

Buyer Phone

Owner Name(Required)

Owner Email(Required)

Owner Phone(Required)

Credit App Signed by Officer?(Required)

YES

Has the customer signed the credit application?

Type of Business

NAICS Business Category(Required)

Choose correct business sector

Business Sub Category (Agriculture, Forestry, Fishing and Hunting)(Required)

Choose appropriate category

Business Sub Category (Mining, Quarrying, and Oil and Gas Extraction)(Required)

Business Sub Category (Utilities)(Required)

Business Sub Category (Construction)(Required)

Business Sub Category (Manufacturing)(Required)

Business Sub Category (Wholesale Trade(Required)

Business Sub Category (Retail Trade)(Required)

Business Sub Category (Transportation and Warehousing)(Required)

Business Sub Category (Information)(Required)

Business Sub Category (Finance and Insurance)(Required)

Business Sub Category (Real Estate and Rental and Leasing)(Required)

Business Sub Category (Professional, Scientific, and Technical Services)(Required)

Business Sub Category (Management of Companies and Enterprises)(Required)

Business Sub Category (Administrative and Support and Waste Management and Remediation Services)(Required)

Business Sub Category (Educational Services)(Required)

Business Sub Category (Health Care and Social Assistance)(Required)

Business Sub Category (Arts, Entertainment, and Recreation)

Business Sub Category (Accommodation and Food Services)(Required)

Business Sub Category (Other Services (except Public Administration))(Required)

Business Sub Category (Public Administration)(Required)

Credit Application already submitted?(Required)

Do you have a credit application to upload?(Required)

If you have a filled out credit application upload it here

Attached Credit Application terms & conditions(Required)

Max. file size: 256 MB.

Attach credit form PDF.

How did we find this customer?(Required)

Where did they come from

Additional Info that would assist in credit decision.

*IMPORTANT: Enter any additional information that would assist in the credit decision. This information will be used to determine the outcome.

This field is for validation purposes and should be left unchanged.

2200 Huntington Dr., Unit C
Fairfield, CA 94533

Toll-free: 1-800-831-8473
Fax: 707-437-4800