Dealer Center

Dealer Center

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Dealer Registration

Please fill out the following form. This form is not a binding contract, but simply a request for a dealer registration packet. The packet will be sent to you either by Fax or US Mail.

Applicant Information	* Denotes required fields.
Business Name: *
Address: *
City: *
State, Zip Code: *
Phone Number: *
Fax Number:
E-mail: *
Dealer Type: *
Business Type: *
Dealer License Number: *
Dealer License Expiration Date: *

Owner(s) Information
First Owner Name: *
Home Address: *
City: *
State, Zip Code: *
Home Phone Number: *
Percent Ownership: *
Date of Birth: *
Last 4 Digits of SSN: *

Second Owner Name:
Home Address:
City:
State, Zip Code:
Home Phone Number:
Percent Ownership:
Date of Birth:
Last 4 Digits of SSN:

Bank Reference
Bank Name:
Contact Name:
Phone Number:

Additional Questions or Comments

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West Central Auto Auction
3277 Ute Avenue - I-80 Exit 117
Waukee, Iowa 50263