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I want to open a New Account with HTD
I want to convert my existing account from COD to Charge
Hornsby Tire Credit Agreement COD to Charge
HTD Account Number
*
Title of the document
Please print ,completely fill out and upload the PDF below.
Upload Completed Credit Agreement
*
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HTD Account Application
Type of Account
*
Independent Tire Dealer
Corporate Retail Chain
New Car Dealership
Used Car Dealership
Government
on site mounting and balancing equipment required
Account Payment Type
*
Pay on Delivery
Charge Account (NET Due 10th)
ACH
Charge Account Requires Signed Credit Agreement
Payment Type
*
Check/Cash
Credit Card (additonal 2.8% Fee per transaction)
Business Name
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
Army Post Office (U.S. Army and U.S. Air Force)
Fleet Post Office (U.S. Navy and U.S. Marine Corps)
State
ZIP Code
Phone
*
Email
*
Date Business Established
*
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Year
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EIN
*
Example: 12-3456789
Sales Tax Exemption Number
*
Owner's Name
*
First Name
*
Last Name
*
Drivers License
*
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Signature
*
[clear]
Use your mouse or finger to draw your signature above
Hornsby Tire Credit Agreement
Title of the document
Please print ,completely fill out and upload the PDF below.
Upload Completed Credit Agreement
*
No File Chosen
File uploads may not work on some mobile devices.
Hornsby Tire Admin
All required documentation in place?
*
Yes
No
Missing Documentation Notes
*
Primary Service Location
*
Dothan, AL
Birmingham, AL
Madison, AL
Columbus, GA
Theodore, AL
Jacksonville, FL
Assigned Sales Rep Email
*
Outside Sales Input
Customer has Retail Store Front?
*
Yes
No
Customer has mounting and balancing equipment?
*
Yes
No
Notes
Proceed with Enrollment?
*
Yes
No
Final Setup
HTD Account Number
*
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