TrukFix ERS Breakdown Requirements This form is to establish National Account Fleet parameters for Continental Tire and the TrukFix Emergency Roadside Service.FLEET INFORMATIONContinental National Account Number* Fleet Name* Primary Contact* Job Title Phone*Mobile PhoneEmail* GENERAL INFORMATION & COMMUNICATIONERS is needed: 24x7 Day Time Hours After Hours and Weekends Estimated daily case volume: 1-5 6-10 Who is authorized to make decisions with our TrukFix Operators?*Select all authorized users that apply. Driver(s) Dispatcher Maintenance Fleet Manager Other Other authorized users?* If the decision makers are not available to provide authorization, TrukFix should:* Continue with the service Delay the service until authorization is obtained Do you require a follow up call upon work completion? Yes No What is your preferred method of communication? Phone Email Invoice RequirementsWhat information do you want to see on your invoices?*Select all that apply. Unit Number Driver Name Wheel Position Reason for Removal Mileage Location Other Other Information* Does your fleet require photos?* Yes No If yes, what photos are required? TrukFix Operators require a Purchase Order to open a case.Which PO options apply to your fleet?*Select all that apply. PO will be issued at time of call Drivers name can be used as PO Unit # can be used as a PO PO will be issued at the conclusion of the case, please contact. Other Other (please specify)* Name First Last PhoneDealer NetworkDo you have preferred dealers (when/where available)?* Yes No List your preferred dealers.* List any Dealer Emergency Roadside Service programs that you wish to avoid. TIRE PREFERENCEWhen and where possible, tires will be replaced with preferred tires based on Customer preference. Approved New Tire Models Select All Continental Tire General Tire Accepted NEW Tire Models:SteersFirst ChoiceSecond ChoiceThird Choice DrivesFirst ChoiceSecond ChoiceThird Choice TrailersFirst ChoiceSecond ChoiceThird Choice Are retreads acceptable to use on TrukFix Calls?* Yes No Accepted Retread Models:SteersFirst ChoiceSecond ChoiceThird Choice DrivesFirst ChoiceSecond ChoiceThird Choice TrailersFirst ChoiceSecond ChoiceThird Choice If a Continental or General brand tire cannot be sourced, TrukFix will attempt to locate a foreign tire. Some servicing dealers will not bill a foreign tire on a Continental account.Is authorization required to source a foreign tire?* Yes No Rank the foreign tires that you prefer in order of preference.Choice 1MichelinBridgestoneGoodyearOtherChoice 1 Account Number If you selected other, please place below. Choice 2MichelinBridgestoneGoodyearOtherChoice 2 Account Number If you selected other, please place below. Choice 3MichelinBridgestoneGoodyearOtherChoice 3 Account Number If you selected other, please place below. Choice 4MichelinBridgestoneGoodyearOtherChoice 4 Account Number If you selected other, please place below. I give authorization to change mismatched tires if tire heights differ.* Yes No Change both tires if more than ____/32 By giving take off tires to the technician you are authorizing them to dispose of the casings.What is to be done with take off tires?*Select all that apply. Your Driver to take Technician to take Servicing Provider to hold for inspection Advanced Solutions:ContiPressureCheck Yes No Units All Units Some Units No Units Additional information about the fleet.Terms of Service* "Continental Tire the Americas, LLC., and its affiliates ("Continental") may use the information that you have provided on your TrukFix Fleet Parameters for marketing and promotional purposes. Completing the TrukFix Fleet Parameters does not obligate you to purchase any products nor obligate Continental to sell you any products. TrukFix will coordinate the service through an accepting dealer. All product pricing and other sale terms shall be subject to Continental's then current Standard Conditions of Sale and policies in effect from time to time." Δ