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Registration Application

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REGISTRATION APPLICATION

                                                                       

2134 W. M-61, P.O. BOX 381, GLADWIN,    MI 48624

PHONE:   1-989-246-0025, TOLL FREE 1-877-246-4204, FAX 1-989-246-0526

www.gdaallc.com

DEALER# FEDERAL ID#
COMPANY NAME
BUSINESS ADDRESS PHONE NUMBERS:
SOLE OWNER (    )      PARTNERSHIP (   )         INCORPORATED (  )
MONTH/YEAR BUSINESS OPENED
TYPES OF VEHICLES ANDPRICERANGE
OWNERS OR OFFICER
NAME: SS#
POSITION: DL#
NAME: SS#
POSITION: DL#
ADDITIONAL AUTHORIZED EMPLOYEES (Will buy/sell at auction)
NAME: NAME:
SS# SS#:
DL# DL#
BANK INFORMATION
BANK PH#
ADDRESS: ZIP:
ACCT# DATE OPENED CONTACT PERSON
NAME OF BONDING/INSURANCE COMPANY: BOND#
AUCTION REFERENCES
AUCTION NAME: STATE:
AUCTION NAME: STATE:
AUCTION NAME: STATE:
DEALER REFERENCES
NAME: PHONE:
NAME: PHONE:
NAME : PHONE:

PLEASE INCLUDE A   COPY OF YOUR DEALER LICENSE, COMPANY CHECK AND SALES TAX#

 

DEALERS   AUTHORIZATION

I hereby give my authorization for the staff of   Gladwin Dealers Auto Auction, LLC to sign as by agent on titles or any other   information necessary on vehicles sold by me through Gladwin Dealers Auto   Auction, LLC.
DATE: OWNER/OFFICER:

 

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