Application Form

Please answer the questions below to see if you qualify to set up an account with Gulf Tire Distributors.

Do you have tire equipment such as tire and alignment machines?*
YesNo
Do you install tires as a service for customers?*
YesNo
Are you looking to purchase parts from us?*
YesNo
Is your business located on a commercial property?*
YesNo

IMPORTANT: You are submitting an application to establish business with Gulf Tire Of Georgia LLC , a DBA Gulf Tire Distributors, may be referred to herein as "GTD".

Consent to e-delivery:

Access to online documents:

To view and print the documents online, you'll need Adobe Reader, version 6.0 or higher. If you don't have Adobe Reader, go to http://www.adobe.com to download it for free.
If you are unable to download, view, and print the documents, or if you do not consent to electronic delivery, it is not possible to submit your application using an e-signature. Contact Gulf Tire Distributors at (770) 723-0089 for assistance or to request a paper copy of any of these materials.
The business application process does not involve any fee charged by us to use our website, but you of course may incur charges from your Internet service provider in order to access information online. Also, your Internet service provider may occasionally experience system failure, and hyperlinks to documents may not function properly.

Duration of e-consent:

This election and consent applies only to the documents required to apply for business. To apply for business with GTD using an e-signature, you must consent by clicking "Sign & Submit" below. By clicking “Sign & Submit,” you consent to receiving the following documents electronically and acknowledge having reviewed, printed, or otherwise received them. If you do not click "Sign & Submit," you cannot apply for business using an e-signature but may download or request paper copies of all documents and apply by fax or mail.

Credit Terms
Standard Terms and Conditions

E-SIGNATURE AGREEMENT

I acknowledge that I have full authority and legal capacity, whether individually or as a representative of a legal entity, both to apply for credit with GTD and to consent to any necessary background check or investigation related to the application for credit.
I understand that attaching my e-signature below is the legal equivalent of submitting a document signed by hand and that clicking on the button below manifests my desire and intent to apply for credit with GTD under, and to be bound by, the Credit Terms and Standard Terms and Conditions referenced above.
I understand that my submission of the electronic Business Application does NOT guarantee that GTD will extend credit to me or to the entity on whose behalf and for whose benefit I am signing and submitting this application.

Fields with an asterisk are required to be filled in before an application can be submitted.

*Business Type:*

Terms Requested*

Note: If you select credit card on file then please provide this details

Driver License

Credit Card Front Side

Credit Card Back Side

Credit Card Authorization Form (Click Here)

Check box if you are an existing Gulf Tire Distributors customer:

Gulf Tire Distributors Account Number:

Business Information

Legal Business Name (as filed with the government)*

Along with this online application please have a Personal Guaranty form filled out for each owner of the entity.

Personal Guaranty Form

Doing Business As (Business name listed on store front)*

Estimated Annual Purchase Volume*

Please select the business classification that best describes your primary source of revenue.

Business Classification*

Number of Locations*

Accts. Payable Contact Person Name*

Accts. Payable Contact Person Email*

Business Phone (ex 1234567890)*

Business Fax

Business Contact Email Address*

Date Present Ownership Started*

Year Business Started*

Federal ID # (ex 11-1111111)*

Tax Exempt Information

Tax exempt forms must be filled out, signed and attached to application

A tax exempt form must be attached or the checkbox must be checked agreeing to pay applicable taxes

Click here for blank Tax Exempt forms by state

Attach completed Tax Exempt form here:

By checking this box you are agreeing to pay applicable taxes

All invoices will be taxed until a signed tax exempt form is received

Invoice/Billing Address

Address*

City*

State*

Zip*

Delivery Address (Shop or Delarship Address Only)

we do not delivery to home addresses

Address*

City*

State*

Zip*

Business Hours*

SETUP FOR WILL CALL

Note: If you have multiple delivery addresses or additional will-call receivers, email info@gulftire.net

Authorized Person Name*

Authorized Person Driver's License Number*

Attached Driver License*

Please list the information of the Owner/Officer/Authorized Individual for the Company

Name*

Home Address*

City*

State*

Zip*

Home Phone*

Name

Home Address

City

State

Zip

Home Phone

Authorized Individual Information

E-SIGNATURE AGREEMENT CONFIRMATION

I understand that attaching my e-signature below is the legal equivalent of submitting a document signed by hand and that clicking on the button below manifests my desire and intent to apply for credit with GTD under, and to be bound by, the Credit Terms and Standard Terms and Conditions which I have received and reviewed.

Authorized Individual should be the party responsible for payment.

Authorized Individual Signature*

Authorized Individual Title*

Authorized Individual Name*

Gulf Tire Distributors Sales Person (if known)

How did you learn of the online business application?

Other

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