Application for Membership

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Firm Name: ______________________________________________________

Street Address: ___________________________________________________

City: ___________________________ State: __________ Zip: __________

Owner's Name(s): _________________________________________________

Home Address: ___________________________________________________

Telephone: (___)__________ Fax: (___)____________ Mobile: (___)__________

Web Site: _________________________ E-Mail: _________________________

Dealership Info: License #______________ Independent ____ Franchise ____

Others Describe______________________________________________________

I certify that (I am or we are) engaged in the used automobile business, or related vehicle industry. I agree upon the signing of this application and, if accepted as a member, I pledge to uphold the bylaws and the constitution of the association, it's code of ethics, and all local, state, and federal laws pertaining to the automobile business.
I authorize NE IADA to send me updates that may be beneficial to my business by phone/fax/or email to the numbers provided above.

Applicant's signature(s): x_______________________________ Date: ________

Member annual dues: $195.00

Support Auxiliary annual dues: $10.00

Make checks payable to: Nebraska IADA
(Call our office to use your credit card)
and mail to:
Nebraska Independent Automobile Dealers Association
P.O. Box 29107
Lincoln, NE 68529
1-800-659-5453

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