Goodyear Off-The-Road (OTR) / Earthmover

Fields with a * are required.

A. Company Information
1.	Company Name *
2.	Street Address *
3.	City *
4.	State/Province *
5.	Zip/Postal Code *
6.	Phone Number *
7.	Fax Number:
B. Person Responsible for Tire Purchases
1.	Name *
2.	Title *
3.	Phone Number *
Your rebate certificate will be e-mailed to this address when the application is submitted.
4.	E-mail *
5.	Confirm E-mail *
6.	It is okay to contact me by e-mail about other Goodyear promotions and offers. * View our Privacy Policy
	Yes     No
C. Company Details
1.	Type of Business *	- Select a type - Construction Government Military Surface Mining Mobile Crane Port & Container Quarry Underground Mine Other
2.	Please enter the number of company owned pieces of equipment in the drop down boxes. A minimum of one selection is required. *
	Articulated Dump Truck:	- Select a value - 0 1 2 3 4 5 6 7 8 9 10 or more
	Motor Grader:	- Select a value - 0 1 2 3 4 5 6 7 8 9 10 or more
	Rigid Haul Truck:	- Select a value - 0 1 2 3 4 5 6 7 8 9 10 or more
	Wheel Loader:	- Select a value - 0 1 2 3 4 5 6 7 8 9 10 or more
	Other:	- Select a value - 0 1 2 3 4 5 6 7 8 9 10 or more
	Other description:
3.	Primary Tire Brand *	- Select a tire brand - Bridgestone Continental Firestone General Goodyear Michelin Toyo Triangle Yokohama Other
D. Promo Code
1.	Promo Code:
E. Comments
1.
For questions or concerns, please contact us at 1-800-227-9531