TireXpress Warehouse Retail & Wholesale Tires
  • Tire Information Blogg
  • Monthly Sales Sign up Page
  • Clearance Tires
  • Online Store
  • About Us
  • How to get the most from your used tires .
  • Flyer
  • Credit Authorization
  • Untitled
Credit Authorization Form

www.tireXpresswarehouse.com

Name of Business


_______________________________________

Full name of credit card owner


_______________________________________


Last four digits of credit card used


_______________________________________


Address for credit card


_______________________________________


Address where shipment is going


_______________________________________


Number of units ( each tire is a unit )

_______________________________________


Price agreed on each unit


_______________________________________


Create a five digit pin ( note any 5 digits you will remember )


_______________________________________



Today's date


_______________________________________


Please print full name and sign


_______________________________________

Please fax this completed form to 607 432 0291



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