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TIM members understand the value of constant customer contact. Please complete this form and you will be contacted to take advantage of this $39.00 introductory offer.

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Additional Information
The questions below will help us determine how best to meet the needs of your company or organization.
Please complete as many as apply.

	Are you currently providing nitrogen service?
	Yes No

	Are you currently a Myers Tire customer?

	How can we help?
	Send a catalog
	Have a sales representative contact me
	I need special information or a quote
	Other, please specify

	Tell us about your business / organization:
	Auto Repair / Service Facility
	Alignment Facility
	Brake Repair / Service Facility
	New Car Dealer
	Truck Fleet
	Government Agency
	Other, please specify

	Questions or Comments?

	Would you like to be updated via email when we publish news or update our catalogs?
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