Fleet Registration Form

1
General Information
2 Contact Information
3 Fleet Information
4 Supporting Documents
5 Submission

General Information

Company Name *

Type Of Business *

Address *

City *

Province *

Postal Code *

Phone *

Fax

Email *

Contact Information

Company Principal *

Title *

Email *

Office Phone *

Account Payable Manager *

Office Phone *

Email *

Mobile

Fleet Manager

Office Phone

Mobile

Fleet Information

Vehicle Count *

Vehicle Travel Area(s) *

(e.g. ON, BC, QC)

Contact Person

Purchase Order *

Yes No

P.O Instructions

(e.g. Driver's first name, vehicle number)

Other Instructions

Payment Options *

Credit (Net 30) At The Time Of Service

PST Exemption *

Yes No

GST Exemption *

Yes No

To qualify for a Net 30 Account, a minimum of 25 vehicles is required. If your fleet consists of fewer than 25 vehicles, please email us at Fleet@mrlube.com, and we will connect you with your local store for further assistance.

Vehicle List(Required):

If you already have a document containing a list of all your vehicles, please email it to fleet@mrlube.com.
If you don't have a document, you may download the template provided below, fill it out, and then email it to us. Vehicle List Form Link
Be sure to include the following application number in your email: KKZ008101856089

Trade References (Required):

Do you already have a document with 3 trade references ?

Trade Reference

Company Name *

Address

Accounting Phone# *

Accounting Fax #

Accounting Contact *

E-mail *

Company Name *

Address

Accounting Phone# *

Accounting Fax #

Accounting Contact *

E-mail *

Company Name *

Address

Accounting Phone# *

Accounting Fax #

Accounting Contact *

E-mail *

Disclaimer

This application is made with the understanding and agreement that all charges are due NET 30 days from the end of the billing month. Any past due amounts are subject to a late charge of 2% per month (24% per annum). This is not intended as an alternative to payment when due. By submitting below, I authorize Mr. Lube + Tires to perform a credit/reference check for use of granting credit terms.

Your feedback is important to us.

COMMENT ON YOUR RECENT VISIT

Fleet Registration Form

General Information

Contact Information

Fleet Information

Vehicle List(Required):

Trade References (Required):

Trade Reference

Reference 1

Reference 2

Reference 3