*Indicates Required Field
  • I am an authorized Bridgestone Firestone dealer/distributor
    • My account number is:*

  • I am authorized to purchase the following BFNT products. (check all that apply)*
    • Passenger/Light Truck Tires
    • Commercial Tires
    • Off The Road Tires
    • Agricultural Tires
  • I maintain an inventory adequate to meet the needs of those government agencies that I service.
    • Yes No
  • I have a knowledgeable Government Salesperson contact
    • First Name: *
    • Last Name: *
    • Phone:       *
    • E mail:       *
  • I have company owned delivery trucks.*
    • Yes No
  • For info purposes only, identify if you can provide standard mechanical service related to the types of vehicles that you are authorized to buy tires for.*
    • Yes No
  • I am authorized to use BSCA’s BFDI/EntireNet*
    • Yes No
  • I have a monitored e-mail address.
    • E-mail address: *
  • I have received, read and understand the 2009 Bridgestone Firestone Government Policy brochure and agree to abide by the policies and procedures listed therein.*
    • Yes No
  • If you would like your website linked to your name on our Government Authorized Servicing Dealer-List, please fill in below: .
    • Website address:
First Name:  *
Last Name:  *
Company Name:  *
Company Address:  *
Zip: *
City And State:
Phone:  *
Fax:  *
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