(800) 453-6247 sales@atlantawheels.com HOME WHEELS TIRES CONTACT DEALERS BECOME A DEALER APPLY TODAY TO RECEIVE WHOLESALE PRICING FOR YOUR BUSINESS! ONLINE APPLICATION Fill out the account application below to join the Atlanta Wheels family. Each type of account requires different information. The form is dynamic and will add fields based the on the information you provide. You will also be required to upload supporting documentation including your Business License and a copy of your Sales & Use Tax Certificate. Credit Card accounts are also required to upload the driver's license for the card you want on file. An account representative will reach out once the account application process has started. Type of Account Please Check All That Apply COD - Cash Only COD - Company Check Company Credit Card Net 30 - 15 Prox. Account Information State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Iowa Indiana 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Billing Information Same as Main Address State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Iowa Indiana 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Accounts Payable Purchase Order Required* Yes No Business Information Type of Business* Corporation LLC Partnership Sole Proprietorship State of Incorporation* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Iowa Indiana 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Company's Business License* Copy of Sales & Use Certification* Copy of Driver's License* Add up to five(5) people that can place orders on you behalf. Confirmation & Signature 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. Signature* CLEAR SUBMIT ATLANTA WHEELS 1668 Sands Place Marietta, GA 30067 (800) 453-6247 accounting@atlantawheels.com You must include the following in your application: Business License Copy of Sales and Use Tax Certification WE DO NOT SELL TO HOME BASED BUSINESSES CONTACT US Atlanta Wheels and Accessories 1668 Sands Place, Marietta, GA 30067 (800) 453-6247 sales@atlantawheels.com CUSTOMER SUPPORT LOGIN TO MY ACCOUNT BECOME A DEALER ACCOUNT APPLICATION GET A QUOTE © 2021 ATLANTA WHEELS & ACCESSORIES. ALL RIGHTS RESERVED