To apply for open credit terms with The Preventative Tire Maintenance Group, please complete and submit our credit application. You may submit it to us online (via the submit button located on the PDF), email, fax or mail it. The PTMGroup will inquire with your bank and the three credit references that you supply in determining whether to extend open credit. Our credit analysts will review your application and respond to you as quickly as possible.

Thank you for your interest in becoming a PTMGroup Customer/Dealer and we look forward to welcoming you to our Customer/Dealer Network.

Credit Application Form
To apply for open credit terms with The Preventative Maintenance Group, please complete and submit our credit application. The PTMGroup will inquire with your bank and the three credit references that you supply in determining whether to extend open credit. Our credit analyst will review your application and respond to you as quickly as possible. Thank you for your interest in becoming a PTMGroup Customer/Dealer and we look forward to welcoming you to our Customer/Dealer Network.
Your Company Information:
Today's Date:*
 / 
 / 
Your Company Name:*
Company Billing Address:*
Name of Company Contact Person:*
Phone of Company Contact Person:*
-
Fax of Company Contact Person:
-
E-mail of Company Contact Person:
Business Filing Type:
Tax Exempt?:
If yes, upload your company status document:
Description of Business:
Company Shipping Information:

Same as billing address:
Company Shipping Address:
Accounts Payable Contact:

Same as company contact?:
Accounts Payable Contact Name:
Accounts Payable Phone:
-
Accounts Payable E-mail:
Accounts Payable Fax:
-
Fed Tax ID/SSC #:
Request Credit Amount (in dollars):
Owner, Partners, or Officers
Signee #1 Full Name:*
Signee #1 Job Title:*
% Ownership stake:*
Signee #1 Social Security Number:
Signee #2 Full Name:*
Signee #2 Job Title:*
Signee #2 % Ownership stake:*
Signee #2 Social Security Number:
Signee #3 Full Name:*
Signee #3 Job Title:*
Signee #3 % Ownership Stake:
Signee #3 Social Security Number:
Bank Information:

Bank Name:*
Bank Account Number:*
Bank Address:*
Bank Contact Person:
Bank Contact Phone:
-
Bank Contact Fax:
-
Credit References:
Reference #1 - Company Name:
Reference #1 - Company Address:
Reference #1 - Contact Name:
Reference #1 - Contact Phone:
-
Reference #1 - Contact Fax:
-
Reference #1 - Contact E-mail:
Reference #2 - Company Name:
Reference #2 - Company Address:
Reference #2 - Contact Name:
Reference #2 - Contact Phone:
-
Reference #2 - Contact E-mail:
Reference #2 - Contact Fax:
-
Reference #3 - Company Name:
Reference #3 - Company Address:
Reference #3 - Contact Name:
Reference #3 - Contact Phone:
-
Reference #3 - Contact Fax:
-
Reference #3 - Contact E-mail:
Submission:
The information provided is true and correct. By clicking "submit" I grant The Preventative Tire Maintenance Group permission to perform a check with the above referenced bank/financial institution and trade references.
Word Verification: