Buyer Registration Form:  ** Indicates a Required Field

**Company Name

**Company Type:

**Years in Business:

**Owner First Name

**Owner Last Name

**Position in Company:

**Street Address

(No PO Box allowed)

**City

**State

**ZIP/Postal Code

**County

**Phone:

**Fax

**Mobile

**Email address

Mailing Address (Enter if different):  (Check if same as above: )

**Street Address

**City

**State

**ZIP/Postal Code

**County

Driver's License     (Copy required)

**DL Number

**DL State

**Date Of Birth (MM-DD-YYYY)

**DL Country

**DL Exp Date (MM-DD-YYYY)

**Social Security#

(No dashes)

Licenses/Tax ID’s
Copies required.

License Number

State of Issue

Effective Date (MM-DD-YYYY)

Expiration Date (MM-DD-YYYY)

**Federal Tax ID

**Dealer License

Salvage License

WholeSale Dealer License

**Sales Tax License

Login Information:

**USERID Primary Bidder

Must be minimum of 8 characters

**Password

**Email Address

References: (Must Be Companies no Personal references)

**Business Name

**Contact Name

**Phone Number

**Business Name

**Contact Name

**Phone Number

**Business Name

**Contact Name

**Phone Number

Payment Information:

**Bank Name

**Bank Address

**Bank City

**Bank State

**Bank Zip

**Bank Phone

**Contact Person

**Account#

Account#

All required photo copies must be received before your registration will be verified. You will receive an email notification that your Username and Password is now valid for use with our site.