Myvipauctions.com



[pic] 4600 Browns Bridge Rd

Cumming, GA 30041

Suite B

Office 678-889-7776

Fax 470-407-6995

info@



REGISTRATION FORM

What We Need From You

___ Used Car License ___Tax Exempt Certificate ___Surety Bond ___ Driver’s License ___Company Check (if paying by check) ____Master Tag

Dealership Information

Used Motor Vehicle Dealer #_________________ Taxable __N __Y Sales Tax # _____________

Name of Dealership ___________________________________________________________

Phone Number at Dealership___________________________Fax __________________________

Dealership Address ___________________________________________________________________________

City ___________________________________________ State ________________ ZIP ____________________

Email Address ________________________________________________________________________________

Owner Information

Owner Name (FIRST) __________________________ (LAST) __________________________

Owners Home Address _________________________________________________________________________

City ___________________________________________ State ________________ ZIP ____________________

Home Phone ____________________________________ Cell__________________________________________

Email Address ________________________________________________________________________________

Owners DL # ___________________________ STATE________

Additional Owners Name (FIRST) ______________________ (LAST) ________________________

Additional Owners Home Address ________________________________________________________________

City ____________________________________________ State ________________ ZIP ____________________

Home Phone ____________________________________ Cell__________________________________________

Email Address ________________________________________________________________________________

Owners DL # ___________________________ STATE________

Payment Information PAYMENT MUST BE RENDERED THE DAY OF SALE OR ADDITIONAL FEES APPLY.

Payment by: ____Cash ____Company Check (Must complete the “Banking Information” form) ____Floorplan (ADF, AFC, CARBUCKS, NEXTGEAR, Westlake, AC,and FPX accepted) fee applies)

Authorized Representative Signature

Licensed Owner(s) ________________________________________________________ Date ____/____/____

VIP Auction Representative _____________________________________________ ___Date ____/____/____

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