Yes     No

I prefer not to receive information by mail from other companies not affiliated with Tire Business.

Select your Job Function President/C-level Manager VP Marketing/Sales/Operations/Business Development VP Engineering/Research/Technology Manager/Director - Marketing/Sales/Operations/Business Development Manager/Director - Engineering/Research/Technology Engineer/Researcher/Scientist Business/Sales Staff Educator Professional Services/Consultant Other (please specify)

Please specify for Other:

Select Number of Employees Less than 50 50-99 100-499 500-999 1,000-4,999 5,000-9,999 Greater than 10,000

Yes, please auto-fill my contact information for other publication qualification forms.

Independent tire dealers who sell and service tires, including retail and wholesale, retreaders, importers/exporters, commercial tire dealers, and multi-location tire dealers

Single Unit

Multiple Unit

Non-Tire Manufacturing Franchise

Company owned outlets of tire manufacturers

Company owned outlets of non-manufacturing tire sellers

Headquarter offices of non-manufacturing tire sellers, service stations, oil and automotive jobbers, and specialty tire shop/jobbers handling equipment and materials for retreaders and tire dealers

Manufacturers of tires, batteries, and accessories

Others allied to the tire and automotive field (please specify)

Answer questions 3-6 only if you are an independent tire dealer.

Yes     No

Less than $599,999	$2,500,000 to $4,999,999
$600,000 to $999,999	$5,000,000 to $9,999,999
$1,000,000 to $1,499,999	$10,000,000 and over
$1,500,000 to $2,499,999	Unknown

Commercial Tires	Farm Tires
Specialty Tires	Wheels

Yes     No

Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa 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 Other

Yes     No

Yes     No

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