Become a Dealer

Type of Account

Please Check all that Apply

COD - Cash Only

COD - Company Check

Company Credit Card

Net 30 - 15 Prox.

DOWNLOAD THE CREDIT CARD AUTHORIZATION FORM AND FAX TO (770) 955-8646

Account Information

Legal Name of Company

Phone

Address

City

State

Zipcode

Billing Information

Our billing information is different than the main address

Address

City

State

Zipcode

Accounts Payable

First Name

Last Name

Phone

Fax

Purchase Order Required

Yes

Business Information

Type of Business

Corporation

LLC

Partnership

Sole Proprietorship

Number of Years in Business

State of Incorporation

Date of Incorporation

Federal ID #

Sales & Use Tax #

Company's Business License

Maximum file size: 134.22MB

Copy of Drivers License

Maximum file size: 134.22MB

Copy of Sales & Use Certification

Maximum file size: 134.22MB

Add up to five (5) people that can place orders on your behalf

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Trade Reference

Name

City

State

Phone

Fax

Add Remove

Bank Reference

Account Number

Date Opened

Name

Branch

Address

Phone

Fax

Confirmation & Signature

Authorization for Release of Supplier Information

Authorization for Release of Supplier Information

Yes, I authorize my Trade References listed to furnish credit information to Torque Wheels in Marietta, Georgia, for the purpose of opening a charge account with their company.

By checking this box and entering your phone number in the form above, you agree to receive text messages from Torque Wheels. Please review our Privacy Policy for more information. SMS Consent is not a condition of any purchase. Message frequency varies. Message and data rates may apply. Reply HELP for help and STOP to cancel. (Optional)

Authorization for Application Dealer

Must be signed by an Owner, Partner, Principal Officer, or Designed Signee

Yes, I am authorized to complete this application and certify the above information is true and complete to the best of my knowledge. I authorize our bank and vendors to release information needed for the purpose of establishing credit worthiness. It is agreed that if credit is granted, the method of payment will be met according to the terms on the invoices. If payment is not made and our account is referred for collection, I promise to pay all collection costs, attorney's fees, and court costs incurred in order to collect any unpaid bills. I also agree to pay a late fee of one and one-half percent (1.5%) per month on all past due monies.

First Name

Last Name

Title

Signature

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Online Application

Type of Account

Account Information

Billing Information

Accounts Payable

Business Information

Add up to five (5) people that can place orders on your behalf

Trade Reference

Bank Reference

Confirmation & Signature

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