Page 26 - PIADA-FEB 2022-Final-web_Neat

MARYLAND FORMS DEALERS CAN ORDER PENNSYLVANIA FORMS DEALERS CAN ORDER

SECURE FORMS QUANTITY PRICE TOTAL $ DUE DESCRIPTION QUANTITY $ MEMBER $ NON-MEMBER MEMBER EXT NON-M EXT
Secure Power of Attorney (3 part-50 per package) _____ $ 20. $ ________ “As is” Supplemental Statement _____ $ 24. $ 48. $ _______ $ _______
00*
00
00
Secure Dealer Reassignment (1 part-100 per package) _____ $ 20. 00 $ ________ Buyers Guide Plastic Holders (50) _____ $ 40. $ 80. $ _______ $ _______
00
00
Shipping Cost: Total Secure forms order ________ Buyers Guide Window Form _____ $ 20. $ 40. $ _______ $ _______
$
00
00
1 – 4 packs = $10.00 6% Maryland Sales Tax ________ Buyers Guide Window Form (Spanish) _____ $ 18. $ 36. $ _______ $ _______
00
00
5 – 10 packs = $15.00 Shipping ________ Consignment & Sales Agreement Form _____ $ 25. $ 50. $ _______ $ _______
Over 10 packs – Please call ahead for pricing.
00
00
TOTAL enclosed for Secure forms ________
$
00
Deal Jackets _____ $ 30. $ 60. $ _______ $ _______
00
00
00
NON-SECURE FORMS QUANTITY MEMBER NON- MEMBER TOTAL $ DUE Fees Chart (wall mount) _____ $ 14. $ 28. $ _______ $ _______
$
$
00
Cash Sales Contracts (100 per pack) _____ $ 47. 00 $ 94. $ ________ Fraud Hotline Poster _____ $ 14. $ 28. $ _______ $ _______
00
00
Odometer Mileage Statement (100 per pack) _____ $ 18. 00 $ 36. 00 $ ________ Installment Sales Contract (100) _____ $ 150. $ 300. $ _______ $ _______
00
00
FTC Buyers Guide (100 per pack) _____ $ 28. 00 $ 56. 00 $ ________ Interpreter Confirmation of Translation _____ $ 25. $ 50. $ _______ $ _______
00
00
Check one:  AS IS  IMPLIED Key Tags (250) _____ $ 32. $ 64. $ _______ $ _______
00
00
Restricted Power of Attorney (100 per pack) _____ $ 10. 00 $ 20. 00 $ ________ Lease Agreements _____ $ 78. $ 156. $ _______ $ _______
00
00
Deal Jackets (100 per pack) _____ $ 24. 00 $ 48. 00 $ ________ Limited Warranty _____ $ 26. $ 52. $ _______ $ _______
00
00
Test Drive Agreements (100 per pack) _____ $ 28. 00 $ 56. 00 $ ________ No Purchase Required Disclosure _____ $ 24. $ 48. $ _______ $ _______
00
00
$
Total Non-Secure forms order ________ Notary Receipt Pad _____ $ 15. $ 30. $ _______ $ _______
00
00
6% Maryland Sales Tax ________ Odometer Mileage Statement _____ $ 18. $ 36. $ _______ $ _______
00
00
$
TOTAL enclosed for Non-Secure forms _________ Power of Attorney Disclosure Forms _____ $ 18. $ 36. $ _______ $ _______
00
00
TOTAL AMOUNT DUE _________ Rental Agreements _____ $ 32. $ 64. $ _______ $ _______
$
00
00
00
Dealership ________________________________________________________________________ Retail Buyer Order Form _____ $ 32. $ 64. $ _______ $ _______
00
Secure Power of Attorney _____ $ 45. $ 45. $ _______ $ _______
00
00
Dealer # (required) _________________________________________________________________
Secure Power of Attorney Log Book _____ $ 15. $ 30. $ _______ $ _______
00
00
Member  Yes  No Contact Name ___________________________________________ Temp Tag Log Book _____ $ 15. $ 30. $ _______ $ _______
00
00
00
00
Email _____________________________________________________________________________ Title Release Authorization _____ $ 15. $ 30. $ _______ $ _______
00
Used Vehicle Record _____ $ 15. $ 30. $ _______ $ _______
00
Address __________________________________________________________________________
(FEDEX & UPS WILL NOT DELIVER TO P.O. BOX) ADP FORMS
City_______________________________________________State ______Zip _________
Customer Delivery Check List _____ $ 28. $ 56. $ _______ $ _______
00
00
Phone ______________________________Fax ______________________________________ Customer Proposal _____ $ 28. $ 56. $ _______ $ _______
00
00
00
00
Card Type:  VISA  MasterCard  AMEX Damage Disclosure _____ $ 28. $ 56. $ _______ $ _______
00
Delivery Confirmation _____ $ 28. $ 56. $ _______ $ _______
00
Name on Card ___________________________________________________ Exp. Date________
00
Goodwill Repair Acknowledgement _____ $ 28. $ 56. $ _______ $ _______
00
Card Number _____________________________________ Security Code________ Insurance Coverage Acknowledgement _____ $ 28. $ 56. $ _______ $ _______
00
00
Lease Spot Delivery Agreement _____ $ 28. $ 56. $ _______ $ _______
00
00
Make checks payable to: PIADA or fill out payment information below:
Notice to Co-Signer _____ $ 28. $ 56. $ _______ $ _______
00
00
Card Type:  VISA  MasterCard  AMEX  Discover Trade-In Appraisal _____ $ 28. $ 56. $ _______ $ _______
00
00
$
Name on Card ___________________________________________________ Exp. Date________ Subtotal _______ $ _______
6% Pennsylvania Sales Tax _______ $ _______
$
Card Number _____________________________________ Security Code________
Shipping $ per pound + Special Shipping $ at cost. Total w/o shipping $_________
We cannot process orders until payment is received. Please make checks payable to PIADA, 1501 North Front St., Harrisburg, PA 17102
(call in to receive shipping cost to include in payment) or you may fax orders to
Signature ____________________________________________ Date ___________________ 717.238.3870 with credit card information. *All orders MUST be accompanied by a
For questions you may contact Cynthia Slemons at method of payment. *Must provide DIN if applicable.
717.238.9002 ext. 16 or Cynthia@piada.org. Dealership ________________________________________________________________________
Contact_______________________________________________Date ________________
FOR INFORMATION ON MEMBERSHIP... Address __________________________________________________________________________
MIDATLANTIC IADA = PIADA + MDIADA + DEIADA City_______________________________________________State ______Zip _________
Contact Shannon at 717.238.9002 x 18
Shannon@piada.org Phone _____________________Fax ____________________*DIN ___________________
www.piada.org • www.mdiada.org • www.deiada.org Card Type:  VISA  MasterCard  AMEX
JOIN TODAY! Name on Card ___________________________________________________ Exp. Date________
MidAtlantic Regional
Pennsylvania | Maryland| Delaware
Independent Automobile
Dealers Association Card Number _____________________________________ Security Code________
All forms come in packs of 100 unless otherwise noted.
24 | MIDATLANTIC DEALER NEWS | MIDATLANTICAUTODEALERSUNITED.ORG • FEBRUARY 2022