ROADHOUSE AUTOMOTIVE EVENTS

BUYER REGISTRATION
PERSONAL INFORMATION
FIRST NAME:
MIDDLE:
LAST NAME:

ADDRESS:

CITY:
STATE:
ZIP:

CELL PHONE #:
HOME PHONE #:

EMAIL:

DRIVER LICENSE #:
STATE ISSUED:


DEALER INFORMATION
DEALERSHIP NAME:
DEALER LICENSE #:
STATE:

DEALIERSHIP ADDRESS:

CITY:
STATE:
ZIP:

CELL PHONE #:
WORK PHONE #:


PAYMENT METHODS
Choose:
CASH
CASHIERS CHECK
CHECK W/BANK LETTER (ORIGINAL)
BUYER COMMISION
VEHICLES = 7%
MEMORABILIA = 10%


BANK NAME:
CONTACT:

ADDRESS:
PHONE:

ACCOUNT:
FAX:
A CREDIT CARD CANNOT BE USED TO PAY FOR A VEHICLE

BY SIGNING BELOW, I AGREE AND I TAKE OWNERSHIP AND RESPOSIBILITY OF ITEMS PURCHASED AND I AGREE THAT THE ABOVE INFORMATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE.

BUYER SIGNATURE:
DATE:


Complete, print and mail to:
Atlanta Auction Co.
28100 Cooks Town Ct.
Bonita Springs, FL 34135


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