TAT FAX SUBSCRIPTION FORM

****Complete all applicable information****
Print and fax this form to 615-595-6903

Fill in the following information about you/your business.

Date_____________________

Business Name/Your Name_______________________________________________

Mailing Address______________________________________________________________

City:_____________________________State:_________Zip:__________________

EMail Address: ________________________________________________________

Telephone Number: (______)_____________________________________________

Fax Number: (______)______________________________________________

Please enroll me on the TAT Techline for plan #______(choose 1-5)

Plan 1. Per call $3.50 per minute (*Pay Per Use) *credit card only (suggested plan if usage is unknown)

Plan 2. Twelve month subscription of 400 minutes of service - $1000 ($2.50/minute)

Plan 3. Six month subscription of 206 minutes of service - $550 ($2.67/minute)

Plan 4. Three month subscription of 103 minutes of service - $301 ($2.92/minute)

Plan 5. One month subscription of 34 minutes of service - $100 ($2.94/minute)

If you have any questions or wish to enroll by phone call 1-800-636-6414 or (615) 595-6974 Monday-Friday, 7AM-7PM CST.

American Express/Visa/MC/Discover#: _____________________________________  Secure Card Number ______

Expiration Date: Month____________ Year___________

Billing address if different from mailing address: ______________________________

City _____________________ State ___  Postal Code/Zip ________

Fax form to: (615)-595-6903.

TAYLOR AUTOMOTIVE TECH-LINE
153 Polk Place Drive
Franklin, TN 37064-5736
Phone: (615) 595-6974
Toll Free 1-800-636-6414
Fax: (615) 595-6903