Print this application.  Fill it out completely and fax to 866-630-6886

www.autoauctioneer.com  Dealer Application           Date: ________________

Dealership Name: ______________________________________ Date Business Started: ___________

Legal Name (If Different) _________________________________________________________

Employer Identification # (EIN) _________________________________or

Social Security #(SSN), if Sole Proprietorship: ___________________________________

Company Type: o Sole Proprietorship   o Partnership   o LLC  o Corporation

Business Type: o New  o Used   o Lease   o Wholesale   o Parts   o Salvage

Dealer Type: o Automobile   o Export   o Boat   o Motorcycle   o RV

Lot Address:___________________________________________________________________________

City: ________________________________ St/Prov: __________ Postal Code: ___________

Mailing Address: ____________________________________________________________________________________

City: _____________________________ St/Prov: _______ Postal Code: __________

Bus. Phone#: __________________ Bus. Fax#: __________________

E-Mail Address: _________________________Web Site Address: www._________________________

Liability Ins. Co.: ____________________________ Policy #: __________________ Exp. Date: ______

Owner:

Name: ____________________________________________________ Ownership: ________%

Home Address: ______________________________________________________________________________________

City: _____________________________ St/Prov: _______ Postal Code: _______________

Home Phone #: ____________________ Mobile #: ____________________ Pager #: ________________ D.O.B._____________

SSN #: __________________   Driver’s License #: _______________________ St/Prov: ___

Owns Business Real Estate: (  )Yes (  ) No    Owns Residence: (  )Yes (  ) No # Years at Residence: ______

Owner:

Name: ____________________________________________________ Ownership: ________%

Home Address: ______________________________________________________________________________________

City: _____________________________ St/Prov: _______ Postal Code: _______________

Home Phone #: ____________________ Mobile #: ____________________ Pager #: ________________ D.O.B._____________

SSN #: __________________   Driver’s License #: _______________________ St/Prov: _____

Owns Business Real Estate: (  )Yes (  ) No    Owns Residence: (  )Yes (  ) No # Years at Residence: ______

 References: (List All Other Auctions You Attend)

AUCTION USE ONLY

Bidder Number:______________          Auction:__________________       Approved Method of Payment  _______________________