Dealer Registration WQAA | West Quincy Auto Auction

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Dealer Registration

1. Update Dealer Registration
2. Bank Letter

Update Dealer Registration

Registration Date:

Company Name:

Address:

City:

State / Province / Region:

ZIP / Postal Code:

Country:

Phone:

Phone Fax:

Home Phone:

Cell Phone

Email:

Dealer License:

State:

Number of Years in Business:

Federal ID #:

Sales tax#:

Owner Information

First Name:

Last Name:

Date of Birth:

Address:

City:

State / Province / Region:

Zip / Postal Code:

Country:

Title:

Social Security Number:

First Name:

Last Name:

Date of Birth:

Address:

City:

State / Province / Region:

ZIP / Postal Code:

Country:

Title:

Social Security Number:

Please List Other Auction References You Are Registered At:

- indicates required fields

Bank Letter

Bank Name:

Address:

City:

State / Province / Region:

ZIP / Postal Code:

Country:

Date:

ATTENTION CREDIT REVIEW DEPARTMENT:

I hereby authorize you to release the necessary credit information to West Quincy Auto Auction Inc. Your prompt response in filling out this registration and mailing it to West Quincy Auto Auction Inc. will allow us to conduct business today. Thank you for your cooperation.

Dealership Name:

Account Number:

E-Signature I hereby declare that the details furnished above are true and correct.

(for Bank use)

Dealer is:

A valued customer with good reputation and financial responsibility

Honest and reliable but short on capital

A new customer, our expertise is limited

Satisfactory

Floor Plan Line:

New $

Used $

Account is:

A regular account

A special account

Maximum credit extended:

Secured $

Unsecured $

Balances:

Low

Medium

High

3 figures

4 figures

5 figures

6 figures

Above Information Given By:

Phone:

Do you floor plan this account?

Title:

Security

- indicates required fields

After submitting the form, the PDF file will be available for download

Phone: 573.393.2444

8506 Highway 24, Taylor, MO, 63471

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