CIADA Dealer Membership Application

Are you looking to join as an Associate / Vendor Member?

Dealer Membership

CIADA *

Dealer Member

Dealer Member (2 yr)

NIADA *

Membership (included)

CIADA PAC NC/SC - $50.00

Voluntary contribution to the Carolinas Independent Auto Dealers Association (CIADA) NC/SC Political Action Committee (PAC)

Total Amount

On Behalf Of Organization

Company Information

Dealer # *

Company Name *

Mailing Address *

City *

State/Province *

Zip Code *

Physical Lot Address *

City *

State/Province *

Zip Code *

Company Phone *

Company Fax

Company Email *

Website

Include http:// or https://

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

Check Username Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Password

Confirm Password

Provide a password for the new account in both fields.

Dealer License Holder Information

First Name *

Middle Name

Last Name *

Suffix

Mobile Phone

Email Address *

Additional Customer Information

Please Enter Comments Below

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Vendor Spotlight

CIADA Dealer Membership Application

Company Information

Additional Customer Information

Member Education

Member Education

Auction Coupon App

Auction Coupon App

Dealer News & Updates

Dealer News & Updates

Legislative Updates

Legislative Updates

Vendor Referrals

Vendor Referrals

CIADA Auto Dealer News

CIADA Auto Dealer News

NIADA Membership

NIADA Membership

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