New Customer Form (Page 3 of 3) in pdf

New Customer Form Page 3

Interstar Fleet Services

500 Meijer Drive, Suite 300

Florence, KY 41042

Customer Service: 800-888-1001

NEW CUSTOMER FORM - Page 3 of 3

Please provide applicable national tire account information:

Do units carry spares?

Prefer New, Retread, or Used tires?

1st Choice Natl. Acct. Tire Brand:

Account #:

P.O. # Format:

2nd Choice Natl. Acct. Tire Brand:

Account #:

P.O. # Format:

3rd Choice Natl. Acct. Tire Brand:

Account #:

P.O. # Format:

Please let us know which additional tools will improve your maintenance operation:

Driver Cards

Quantity:

Daily Repair

Name:

Email:

Summary (E-mail)

Online Web Portal

Name:

Email:

Account

InterStar Account

What is your preferred payment method?

Credit Card

Comchek

(subject to credit application approval)

E-mail address for receipts/invoices:

(Receipts/invoices available hard copy format via mail with additional fees)

Submit by Email

Print Form

and fax to 888-363-3658

v1.5

New Customer Form Page 3