Arkansas Independent Automobile Dealers Association

Knowledge-Support-Success

APPLICATION FOR MEMBERSHIP

 Type of Membership:   Regular   ______   Associate   ______ (non-dealers)

Company Name:   _________________________________________________________________

Owner’s Name:   ________________________________________________________________

Physical Address:   ________________________________________________________________

City/State/Zip:   ________________________________________________________________

Mailing Address:   ________________________________________________________________

City/State/Zip:   ________________________________________________________________

Phone Number:   _____________________________     Fax:   _____________________________

E-mail Address:   _________________________________________________________________

Web Address:   _________________________________________________________________

Kind of Business:   (check all that apply)   Independent __   Franchise __   Retail __   Buy Here Pay Here __

Wholesale __   Auction House __   Body Shop __   Re-builder __   Salvage Yard __   Classic Cars __

Annual Dues $250.00
Make checks payable to: AIADA
P.O. Box 147 - Magnolia, AR  71754

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