Interstar

24-Hour Emergency Road Service. Anytime. Anywhere. 1-800-888-1001

Vendor Application

Company:

Physical Location:

City, State, ZIP

Mailing Address (if different):

City, State, ZIP

Organization Type:
Corporation
Partnership
Sole Proprietor

Federal Tax I.D. or Social Security #:

Owner:

Title:

Day Phone #/Night Phone #/FAX #

Pager #/Mobile Phone #/Other Phone #

Service Hours and Availability

Open 24 Hours? Yes No

Monday-Friday - to

Saturday - to

Sunday - to

Rate Schedule			Tow Rate Schedule	Other
	Regular Hrs	After Hrs
Service Call				Wheel Stud Replace	Yes No
Mile Rate Round Trip				Minor Mech. Repair	Yes No
Road Labor				FHWA Inspection	Yes No
Shop Labor			Vol. Disc. to Customer
Tire Change Labor			Std. Misc. Mark-up Fee	Std. Misc. Mark-up on Parts

Tires

1000x20" Bias New Recap (12 ply)

1000x20" Bias New Recap (14 ply)

1000x20" Flap

1000x20" Bias New Tire

11R22.5" New Recap

11R24.5" New Recap

1000x20" Tube

1000x20" Tube New Used

Does your company do Tire Replacements?
Yes No

Does your company do Tire Repairs?
Yes No

Does your company hold Tire Banks?
Yes No