ROUTE 51 SOUTH · P.O. BOX 445 · PERRYOPOLIS, PA 15473
PHONE: (724)
736-4445 ·
1-800-735-5288 · FAX: (724) 736-0466
DEALER REGISTRATION
COMPANY
NAME___________________________________________________OWNER’S
NAME____________________________________________________
ADDRESS______________________________________________________________________________DATE
__________________________________________
CITY
______________________________________________ STATE
________________________ZIP CODE ___________________________________________
BUSINESS
PHONE: AREA CODE ___________ PHONE
___________________________ SALE
TAX EXEMPTION NO. ___________________________
YEARS
IN BUSINESS ____________________________ COMPANY
REPRESENTATIVE ____________________________________________________
ˆ INCORPORATED ˆ PARTNERSHIP ˆ SOLE OWNERSHIP
DEALER D.I.N. NUMBER______________________ TYPE OF
DEALER: ˆ NEW ˆ USED
IS
ACCOUNT IN COMPANY NAME? ˆ YES ˆ NO ACCOUNT
NO. ________________________________________________
BANK
_____________________________________________________ TELEPHONE: AREA CODE _______
NUMBER______________________
BRANCH
NAME ____________________________________________ CITY __________________ STATE_______ ZIP CODE_____________
STREET
_______________________________________________________________________________________________________________________________
DO
YOU FLOOR CARS? ˆ YES ˆ NO IF YES, WHAT FINANCE COMPANY
________________________________________________________
PLEASE SEND A COPY OF DEALER LICENSE AND COMPANY
CHECK ______________________________________________________________________
RESIDENCE
ADDRESS __________________________________________________ OWNER’S NAME
_______________________________________________
CITY
____________________________________________________________________________
STATE______________ ZIP CODE _______________________
RESIDENCE
TELEPHONE INCLUDING AREA CODE _____________________________________________________________________
WE ARE INTERESTED IN ˆ BUYING ˆ SELLING ˆ BOTH
OTHER
AUCTIONS ATTENDED:
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Upon authorization to conduct business at the Perryopolis Auto Auction, the applicant agrees to abide by all auction policies and procedures specifically those concerning odometer tampering which if violated could cause suspension of trading privileges, a monetary penalty assessment for related expenses and repurchase of any odometer tampered vehicle sold by the applicant. The applicant also acknowledges receipt of the Perryopolis Auto Auction Policies.
APPLICANT
SIGNATURE _________________________________________________TITLE
_________________________________ DATE _________________