Membership Application
Affiliate Application
Business Information
Business Name
License Number
Contact Name
Email
Address
City
State
Zip
Tel
Cell
Fax
Type of Business
Type of Business (select all that apply)
Retail
Wholesale
BHPH
Lease
Lease to Own
Service
Average monthly inventory
Number of years in business
Number of employees
Have a floor plan
Yes
No
Service department
Yes
No
Parts department
Yes
No
F & I Department
Yes
No
Monthly Sales
1-10
11-20
21-30
31-50
51-100
100+
Do you sell:
Vehicles 1 to 7 years old
Yes
No
Vehicles older than 7 years
Yes
No
Service Contracts
Yes
No
Gap Waiver
Yes
No
Billing Information
First Name
Last Name
Phone Number
Email
Billing Street
City
State
Billing Zip
Payment Information
Card Number
Expiration Date (MMYY)
CVV
Routing Number
Account Number
I hereby agree to pay the above named company for all charges agreed to for the purchase of the following product or service: understand that I will now be charged a one-time fee of a penny for the purposes of validating my card.
YES it is important to me to be recognized as a professional! Enclosed are my annual dues of
$550.00
to make sure my business has all the advantages NYADA provides to put me at the forefront of my profession. By completing this form, I am consenting and giving NYIADA, its affiliates and subsidiaries, my permission to contact me and provide information to me at the mailing, email address, fax and phone numbers herein listed which I have provided.
Please fill in the required fields