Tire Industry Association - TIRE SAFETY STARTS HERE Order Form

Site Updated: 5.5.09

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Tire Safety Starts Here Order Form

I. OTHER WAYS TO REGISTER
Mail Tire Industry Association 1532 Pointer Ridge Place, Suite G Bowie, MD 20716-1883.	Fax 301.430.7283
Download this form as a PDF file. (click above to download. Then print it, fill it out and send it to TIA)

II. SHIPPING INFORMATION

Name:

Company:

Shipping Address:

City:

State:

Zip:

Country:

If applicable, please enter International Postal Code into the Zip field above.

Phone:

Fax:

E-mail:

III. LIST OF CERTIFIED TECHNICIANS

(Please check type of certification next to each name listed)

ATS

CTS

10.

IV. PRICING INFORMATION

Retail Tri-Fold Brochure

Commercial Tri-Fold Brochure

Commercial Tire Service
Truck Decals

51-500

.25 each

.$1.00 each

501-999

.20 each

(can only order
one per CTS Tech)

1.000+

.15 each

Customized

Call for Price

Shipping and Handling: $10.00 for orders up to $100.00; $20.00 for orders over $100.00.

V. ORDER INFORMATION

Please send me 1 FREE "Tire Safety Starts Here" Kit

(Each Kit includes 50 tri-fold brochures, one showroom poster, and one service truck decal)

Additional Materials	Quantity		Unit Price		Product Cost
Retail Tri-Fold Brochure		X		=
Commercial Tri-Fold Brochure		X		=
Commercial Tire Service Truck Decals		X	$1.00	=
(can only order as many Decals as you have CTS Techs)
Shipping and Handling
(add $10.00 for orders up to $100.00; add $20.00 for orders over $100.00)
TOTAL AMOUNT DUE				=

IV. METHOD OF PAYMENT

Payment :

PO Number:

Card Type:

Expiration:

Card Number:

Name On Card:

Amount: