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First Name:
Last Name:
My job title is:
Company Name:
Company Address:
Address (Line 2):
City:
Province:
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1. How many vehicles are based at (or controlled from) this location?
(Please indicate quantities by type)
Trucks Truck Tractors
Trailers Buses
Off Road Vehicles  

2. Are any of these vehicles in any of the following Gross Vehicle Weight Classes?
Class 8: 33,001 lbs. GVW & over Yes No
Class 7: 26,001 to 33,000 GVW Yes No
Class 6: 19,501 to 26,000 GVW Yes No
Class 3, 4, or 5: 10,001 to 19,500 GVW Yes No
Class 1 or 2: Under 10,000 lbs. GVW Yes No

Are any of these vehicles Refrigerated?
Yes No

3. Do you have maintenance shop facilities at this location?		 Yes No
How many mechanics here?

4. Indicate your primary type of business:

5. Do you specify, select or approve the purchase for any of the following?
(check all that apply)
Trucks, Tractors
Trailers
Powertrain components (engines, transmissions, axles)
Vehicle systems (brakes, lighting, suspension, cooling, electrical)
Tires, Wheels (new or replacement)
Vehicle appearance (paints, markings - new or replacement)
Replacement parts (filters, electrical, engine parts, brakes, suspension, exhaust)
Major replacement components (engine, transmissions, exhaust)
Oils, Additives & Lubricants
Shop equipment and tools
Equipment Leasing
Fleet Tracking
Insurance,Permits,Taxes
Used Trucks/Trailers

No Purchasing Authority at All

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What day of the month were you born?

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