Member Application

Thank you for your interest in joining Midwest Auto Care Alliance. Please complete the application below and indicate your membership type.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Directory Category:

Employees:

Full-time Part-time

Comments / Questions:

Owners Name : *

Spouse Name :

Does your spouse work in the business?: *

If yes please include your spouse email:

Contact's Date of Birth : Select mm/dd/yyyy

Contact Cell Phone:

Do we have permission to text you MWACA information?: *

Do we have permission to fax you MWACA information?: *

Date You Started in Business: Select mm/dd/yyyy

Annual Gross Sales :

Division: *

Primary Chapter: *

Do you have multiple locations?: *

If yes, how many?:

Do you have a valid business license?: *

Do you have liability insurance?: *

Do you have a commercial location?: *

Do you have a sales tax license?: *

Reference: Please list industry reference (Name, Title, Company, Phone): *

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Primary Contact Information

First Name: *

Last Name: *

Title: *

Cell Phone:

Fax:

Email: *

Password:

Billing Contact Information

Same as Primary Contact

First Name:

Last Name:

Title:

Cell Phone:

Fax:

Email:

Password:

Membership Options

Membership Package: *

Midwest Auto Care Alliance Shop Membership: $275.00
Independently owned service or collision repair facility Midwest Auto Care Alliance Allied Membership: $350.00
Available to companies providing products, services and benefits to the automotive service industry * Fees are per year. MWACA Educational Membership: $0.00
Available to educators of an accredited automotive program MWACA Student Membership: $0.00
Available to a current full-time student enrolled in an accredited automotive program

Additional Opportunities:

We will contact you with additional information.

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Payment Option:

Charge my credit or debit card

Print Application

Questions or Comments? Contact Us

5950 N. Oak Trafficway, Suite 201 Gladstone, MO 64118
Phone:
(816) 413-9800