Apply Online This aplication form is for tire resellers only. Optional Fields are identified as such. Legal Company Name: (If different than above) Does Business As: Billing Address: City: Province: Postal Code: Ship to Address (optional): City (optional): Province: Postal Code (optional): Contact Person: Business Phone: Cell (optional): Fax(optional): Email (optional): Type of Business: Business Start Date(MM/DD/YYYY): Tire Levy: PST: GST: Credit References 1 - Company Name: Phone: Fax: 2 - Company Name: Phone: Fax: 3 - Company Name: Phone: Fax: