tyreconnect

tyreconnect Account application

Sender Information
From Name
From E-Mail
example@example.com
Sales Consultant Name*

Trading Information
Nature of Business*
i.e OEM Dealer , Mechanic , Repair Shop, Mobile Mechanic etc
Trading Name*
This is the trading (advertised) name that the business operates under
Full Legal Name*
This is the full legal name (as linked to ABN) that the business operates under, this can be the same as the Trading Name.
ABN*
ACN
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
Do you have tyre fitting equipment?*

Manager Details
Name*

First NameLast Name
Position / Title*
Email*
example@example.com
Business Phone No.

Area CodePhone Number
Mobile No.

Area CodePhone Number

Accounts Department
Sames As Manager Details

YesNo
Name

First NameLast Name
Position / Title
Email
example@example.com
Business Phone No.

Area CodePhone Number
Mobile No.

Area CodePhone Number

Delivery Details
Delivery Contact
Enter Name of person and/or department to accept deliveries
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
Delivery Instructions
Enter any information about delivery instructions for the site.

Trade References
Business Name
Provide the name of a business that you deal with currently that can be contacted by tyreconnect
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number

Agreement & Acceptance
Full Name*
Position*
Date*

DayMonthYear
Date
The signing of this credit application acknowledges the terms and conditions set forth in this agreement.

Signed for and on behalf of the client (subject to approval by tyreconnect):
I am authorised to sign on behalf of the above organisation*

Clear

Internal Information
Additional Information
Credit Limit Requested in AUD
tyreconnect Employee Name
Enter the name of TyreConnect representative that is assisting with completing this form
Type of Account Requested

Credit Card7 Days from Invoice7 Days from Statement30 Days from Statement
Should be Empty: