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? : 
* Do you provide a mobile service : 
If so, how many vehicles? : 
If so, Car and/or Truck Capable? : 
If so, what area will you cover? : 
* Do you provide an out of hours service? : 
* Do you provide a Collection & Delivery Service : 
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? : 
* Are you affiliated with any other Fleet Network? (If yes please give details) : 
* Do you have tyre fitting equipment at your location? : 
* 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 :