Type of Membership:   Regular (Licensed Dealer):   Associate:

Name:	Title:
Sponsor:
Phone:	Fax:     Cell:
Firm Name:	Email:
Address:	City:
State:	Zip:     County:     Dealer Number:
Web Site Address (if one exists):

Areas of Interest:

	Liability:		Bonding:		Lot Liability:
	Group Health:		Business Forms:		Seminars:

Credit Card Number:		Expiration Date:
Card Type:	MasterCard Visa

By checking the box below you indicate your intent to abide by the Washington State Independent Auto Dealers Association Code of Ethics as listed on this Web site.