Full Application - PLEASE COMPLETE!


* E-mail:

* First Name:
* Last Name:

* Date of birth:    
* Social Security Number (No Dashes):
* Gender:
* Marital Status:
* BAH Received:
* Street:

* City:
* State
* Zip Code
* Residential Status
* Mortgage/Rent Payment
* Phone Number:

Work Phone Number:

Cell Phone Number:

* Branch of service

* Pay grade

* Status

* Years Active Service

* Years Reserve Service

* Date Entered (MM/DAY/YYYY)
* End of Enlistment Date (MM/DAY/YYYY)
* Vehicle Year, Make & Model
* How did you hear about us?

* Desired Rim Size

Rims You're Interested In (Manufacturer & Model)

Also email us you're last month pay stub to sales@militarydiscountrims.com.
Please feel free to Call us if you have any questions 866-967-8126

By submitting this application, you are authorizing Military Discount Rims to access your credit file. You are also authorizing a representative from Military Discount Rims and/or it's affiliates to contact you to discuss your application and product selection. This information will be strictly confidential and will not be sold, shared or discussed with anyone outside of the Military Discount Rims.

A representative will contact you within one business day.

* Indicates Response Required