Online Membership Application

Company Name
Contact Person (will be listed on online membership directory)
Street Address
City
State
ZIP
County
Directions to your business from closest major highway:
Federal Tax ID
PA Sales Tax ID
Phone
Toll-Free
Fax
Contact Email
Owner Name
Street Address
City
State
ZIP
Recommended/Nominated by:

National & local memberships
WPADRA
Eastern
SW Phila.
ISRI
None
Other

Information about your business
Date Started
Specialization
# of Full-Time Employees
# of Part-Time Employees
# of Rollbacks
# of Wreckers

Do you have any of the following at your business? (Check all that apply)
Fax
Computers
Internet

Do you have any of the following licenses? (Check all that apply)
WL Tag
PA Salvor
RT Tag
Used Car Dealer
Highway Beautification

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Member benefits include:

Insurance programs
Legal assistance
PennDOT assistance

...and much more!

GJ Sullivan

Hollander, a Solero Company

Online Parts Depot

Ecar

ARA University

Keystone

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