Please provide the required details using the form below.
* Company / Group Name :
Centre name if different :
* Vehicle Franchise :
* Contact Name :
* Address :
* Postcode :
* Telephone No :
* Fax No :
* E Mail Address :
* Credit Control contact :
* Are you Internet Enabled? :
Please select
Yes
No
* Do you provide a mobile service :
Please select
Yes
No
If so, how many vehicles? :
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If so, Car and/or Truck Capable? :
Please select
Car
Truck
Both
If so, what area will you cover? :
* Do you provide an out of hours service? :
Please select
Yes
No
* Do you provide a Collection & Delivery Service :
Please select
Yes
No
If so, what radius/distance is covered? :
* Who is your current tyre wholesaler? :
Wholesale account No (If Viking Account) :
What Tyre Brands are Normal Stock Items? :
Do you have ISO Accreditation? :
Please select
Yes
No
* Are you affiliated with any other Fleet Network? (If yes please give details) :
* Do you have tyre fitting equipment at your location? :
Please select
Yes
No
* Which Axle Group Dealer Division services would be of interest to you?
Tyre Wholesale :
Access to Fleet Accounts :
* Who disposes of your Scrap Items? :
* Please outline your Waste Disposal Procedures:
Please include any relevant certificate for Waste Disposal Procedure :
* Public Liability Insurance Provider: :
Please attach a copy of the Certificate of Insurance :
Date of visit if required :
Date added to Network :
Merchant number allocated :
Notes :
Network Manager :
Date Authorised :
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