WHEEL’D Onsite Services Signup Form

WHEEL'D Onsite Services Signup Form

Thank you for considering WHEEL'D for your onsite fleet inspection and maintenance services. Please complete the form below and a WHEEL'D representative will be in contact with you.

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Name *

First

Last

Business Name *

Job Title or Role *

Primary Contact Email *

Primary Contact Phone Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Number of Sites Where Your Fleets Operate

Total Vehicles in Your Fleet(s)

Number of Sites You Want WHEEL'D Services *

If more than 3 sites, please note it in comments.

Email to Send Detailed Receipts (if any)

Referred by *

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Fleet Location 1

Fleet Location 1 (City, State) *

Company Brand (i.e. FedEx, Amazon, Joe's Electric, etc.) *

Location Main Contact Name *

First

Last

Location Contact Email *

Location Contact Phone *

Number of Vehicles to add to the WHEEL'D Program *

VEHICLE DETAILS: Enter Vehicle #, License Plate, and State Registered (please enter one vehicle per line)

(You can enter it now, or we can do it during the first site visit)

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Additional comments or questions

Fleet Location 1

Fleet Location 2

Fleet Location 3