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Application

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To pay by check, please download our PDF application by clicking one of the links below:
New Car Dealer Membership
Used Car Dealer Membership
Allied Membership

Membership Type

Organization Information Organization Information

Dealership Name Company Name

First Name

Last Name

Title

Physical Address

Address 2

City

State

Zip

Phone

Fax

Website

Dealer/Owner

First Name

Last Name

Title

Physical Address (If Different)

Address 2

City

County

State

Zip

Phone (If Different)

Email Address

Does your company have a different main contact other than the person listed above? NoYes

Main Contact

First Name

Last Name

Physical Address (If Different)

Address 2

City

County

State

Zip

Title

Phone

Additional Employees

Employee 1

First Name

Last Name

Title

Email Address

Phone (If Different)

Employee 2

First Name

Last Name

Title

Email Address

Phone (If Different)

Employee 3

First Name

Last Name

Title

Email Address

Phone (If Different)

Employee 4

First Name

Last Name

Title

Email Address

Phone (If Different)

Employee 5

First Name

Last Name

Title

Email Address

Phone (If Different)

Employee 6

First Name

Last Name

Title

Email Address

Phone (If Different)

Employee 7

First Name

Last Name

Title

Email Address

Phone (If Different)

Employee 8

First Name

Last Name

Title

Email Address

Phone (If Different)

Employee 9

First Name

Last Name

Title

Email Address

Phone (If Different)

Employee 10

First Name

Last Name

Title

Email Address

Phone (If Different)

Membership Dues

Annual Units Sold

Annual Membership Dues

Total

* Contributions or gifts to the Kentucky Automobile Dealers Association are not tax deductible as charitable contributions. However, they may be tax deductible as ordinary and necessary business expenses.

The contents of this box are for testing purposes. This box will be removed when the form goes live.

Additional Items

Additional Categories Cost

One-Time Application Fee

Tax

Primary Directory Category

Additional Directory Categories

Select additional directory categories below by holding the "CTRL" key
Secondary categories may be subject to additional fees

Number of Full Time Employees

Number of Part Time Employees

Number of Rooms

Number of Associates

Number of Locations

Millions in Assets

Enhanced Membership ($50)

Full-Time Employees

Part-Time Employees

Hotel/Motel Rooms

Restaurant Seats

Additional Associates

Additional Associates Cost

Additional Locations

Additional Locations Cost

Assets

Assets Cost

Additional Categories

Number Of Additional Categories

Additional Categories Cost

Additional Item 1 Cost

Additional Item 2 Cost

Additional Item 3 Cost

Additional Item 4 Cost

Additional Item 5 Cost

Additional Item 6 Cost

Additional Item 7 Cost

Additional Item 8 Cost

Additional Item 9 Cost

Additional Item 10 Cost

Annual Dues (charged to card)

Revenue Item

Tax (charged to card)

Fee (charged to card)

Temp Value For DropDown 1

MembershipType

Additional Item 2

Additional Item 3

Additional Item 4

Additional Item 5

Additional Item 6

Additional Item 7

Additional Item 8

Additional Item 9

Additional Item 10

Payment Type

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

Credit Card Information

Credit Card Type MastercardVisaDiscoverAmex

Credit Card Number

Name on Card
Security Code
Valid Through
Address
City
State
Zip
Phone
Credit Card Email Address

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Please select a membership type before submitting your application.

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To pay by check, please download our PDF application by clicking one of the links below: New Car Dealer Membership Used Car Dealer Membership Allied Membership

Application

To pay by check, please download our PDF application by clicking one of the links below:
New Car Dealer Membership
Used Car Dealer Membership
Allied Membership