Automotive Recyclers of Michigan

Membership Application

Date:	Dealer License No.:
Company Name: Address:
City:	State:
Phone: 800#	Fax:
Owners Names:	SS#

Have any of the principal owners named above been convicted of a crime in the past 10 years?
No	Yes
Dates and details:
Has the dealer license for the above company ever been suspended, terminated or revoked?
No	Yes
Dates and details:
Name of Manager(s):	Number of employees:
Number of yard acres in use:	Number of parts cars purchased per year:
Number of repairable vehicles per year:
Methods of purchasing vehicles:	Contract
Private Parties	Car Dealers
Salvage Pools	Other
How many years has the company been in business?
How many years has this location been used as a salvage yard?

Credit References (4) (Someone to whom you have regular charges)
Name:	Business Name:
Address:	Business Address:
Telephone:	Telephone:


Name:	Business Name:
Address:	Business Address:
Telephone:	Telephone:

Name:	Business Name:
Address:	Business Address:
Telephone:	Telephone:

Name:	Business Name:
Address:	Business Address:
Telephone:	Telephone:

Email Address:
Send photocopies of each of the following along with your check for $395.00 made payable to ARM: Sales Tax License State Dealer License Local salvage (or "junkyard") license I swear that the statements contained in the forgoing application are true and that I, as owner, member of a partnership, or an officer or director of the corporation, have authority to submit this application and to make the statements contained herein. Any misleading, incomplete, or false statements shall be grounds for the denial of this application, or suspension or revocation of my membership.