Application Form "Submit" to us online or fax this page to us to quickly process the setup.
Or print and mail this form with payment to address below.

"Your Local USA CityMall Program"
Indicate
Number
of pages
order.
 
Quantity FundRaiser
Price
GetFree
 Description
Pages
$6 ea
Your own page
 Buy pages in multiples of 5, minimum of 10
<-- Please enter page ID number of person that refer you to us. (if known)

Dealer Information

Your entry must match the name and address on your credit card.
First name
Last name
Bus. Organization
Payto: SS or Fed ID (Optional)
Email address
Web addr. URL if any
Street address
City
State
Zip/Postal
Phone (with AC) 
Fax

Payment Information
All of your payment information is kept strictly confidential
Expire
Check or Money Order: Make checks and money orders payable to TimcoUSA. Preferred payment method: Automatic Credit Card Debit I (We) hereby authorized TimcoUSA, hereafter referred as "Seller", to initiate debit entries (withdrawals) to my accounts as indicated and Credit Card Companies to debit the same to such accounts. This authority is to remain in full force and effect until "Seller" and Credit Card Companies have received written notice from me (or either of us) of its termination in such manner as to afford "Seller" and Credit Card Companies a reasonable opportunity to act upon it. 
Print & Fax 361/668-0036
or Mail with payment to:----->
---OR Email ------>
 TimcoUSA
Regional office
427 So. Reynolds St.
Alice, Texas 78332
If you prefer you can email this form here 
this is a secured site. Just press submit
Submitting this form means that you agree with Timco terms and conditions
I agree to comply with all the terms and conditions listed on page 2 of this agreement.
I understand that I have the right to terminate my Dealership business at any time with or without reason. I understand and agree that this agreement does not constitute the sale of a Franchise or Dealership and that there are no exclusive territories granted or guarantee to me 

YOUR SIGNATURE :_______________________________      Date ___________________________


Corporations only, complete the following: 1) State of incorporation _________.  Attach a list of Names and Social Security numbers of all shareholders, directors and officers.
2) Resolve that ______________________ (name of corporation) is authorized to enter into a Timco Dealership application and agreement with Timco and to execute all and any documents necessary to conduct business with Timco. We certified that this resolution was adopted by the Board of Directors of ______________________ (name of corporation) on ______________ (date) at a meeting of the Directors of this corporation properly called, and shall continue in effect rescinded by resolution duly adopted by the Board of Directors of this corporation, notice of which shall be signed by the President of this Corporation and provide to Timco . Each shareholder, director, and officer acknowledges that, in addition to the obligations and responsibilities of the corporation, they are personally and individually bound to and must comply with the terms and conditions of the Dealership Application and Agreement, Policies and Procedures, and the Compensation Plan.

President     ____________________________             Secretary   _______________________________________      Date ________________________