Date: Secondary Account Information Total Service Support

Add Update Terminate If Terminate, Remain in WISE Account # 6 Account Name Non-type Specific Classification Non-type specific classifications Locator 2% Rewards Locator classifications (TSS only)*
TSS accounts are placed on the Locator as Service Provides. If your TSS customer is selling Retail Parts and wants to be classified on the Locator as a Retail Parts Provider and a Service Provider, check the box .

Region / Zone / Market

Representative Name Representative Email Representative VME Profile Overview ACDelco Account Number 6
Business Name Owner/Manager Business Street Address City Phone Email Web Site Address / URL PO Box PO State PO City PO Zip State Fax Zip

Check here if this account should receive mail (bulletins, brochures, letters, etc.) Attention for Mailing

Hours of Operation

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

from from from from from from from -

to to to to to to to -

Product Lines Purchased

Purchase Requirement Option Line No. Line Name Line No. Line Name

01 02 03 04 05 06 07 08 09 10 12 13 14 15 16 17 18 21 24 25

Ignition Parts Bearings/Oil Seals Gauges & Cable Radiators Shocks/Struts Electronics Batteries Wiper Products Aftermarket Suspension Products Chemicals Aftermarket Thermostats/Caps Thermostats/Caps Durastop Brakes Air Conditioning Wire & Cable Brake Parts Automotive Motors Emission Control Instrument Clusters Water Pumps

26 27 31 33 35 36 37 38 39 40 41 42 43 45 47 48 50 51 55 59

Water Pumps Aftermarket Electronics Starter and Alternator All Makes Starters & Alternators Belts & Hoses Steering and Drive Systems Transmission Parts Clutch Kits and Parts Engines Transmissions Spark Plugs Oil Filters Fuel Pumps Chassis Parts Fuel Filters Air Filters Transmission Filters Engine Components Light Bulbs Misc Parts
Rev 03/05/07

* All Information Is Required Unless Indicated Otherwise.

Account Information Total Service Support

Cardholder Information
Is owner/manager cardholder? Is business address same as home address? Cardholder Yes Yes No No Account # 6 Account Name

First

MI

Last

Last 4 Digits Only of Social Security Number

Home Street Address

City

State

Zip

Partners Information (Optional) Cardholder Name

First

MI

Last

Social Security Number Home Street Address

City

State

Zip

Sponsoring Direct Account 9

Direct Name

Additional Supplying Accounts

2 Second Account
6-digit number beginning with 9 or 6

4 Fourth Account
6-digit number beginning with 9 or 6

Account Name 3 Third Account

6-digit number beginning with 9 or 6

Account Name

Account Names

* All Information Is Required Unless Indicated Otherwise.

Rev 03/05/07

Account Information Total Service Support Account # 6 Account Name

Store Information
Meets appearance guidelines Image participant Business photo attached Number of Bays
Minimum two (2)

Staff
Yes Yes Yes No No No Automatic Transmission Brakes Electrical Engine Mechanical Engine Performance Heating and A/C Mechanical Transmission And Axles Steering and Suspension MASTER Number of Technicians How many technicians in each ASE certification area?
You must have at least one ASE certified technician on staff.

Service Performed Underhood Undercar Honors ACDelco Battery Warranty General Repair & Maintenance Brakes Steering & Suspension Heating & Air Conditioning Engine Mechanical Towing (During Business Hours) Retail Parts HVAC Powertrain Other or Specialized Services Electrical Automatic Transmission Mechanical Transmission & Axles Engine Performance Towing (24 hour) Wholesale Parts VSC (Vehicle Service Contract)

* All Information Is Required Unless Indicated Otherwise.

Rev 03/05/07