Member Application

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

Step 1: Member Info

Step 2: Additional Info

Step 3: Primary Contact

Step 4: Billing Info

Step 5: Membership Options

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

Website

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

City *

Please add your City.

State *

Please add your MN.

Postal Code *

Please add your Postal Code.

Country *

Please add your country.

Mailing Address

Same as physical address

Address line 1

Address line 2

City

State

Postal Code

Country

Step 2:

Additional Info

Directory Category

Full-time Employees

Part-time Employees

Owners Name *

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Spouse Name

Does your spouse work in the business? *

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If yes please include your spouse email

Contact's Date of Birth

Contact Cell Phone

Do we have permission to text you MWACA information? *

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Do we have permission to fax you MWACA information? *

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Date You Started in Business

Annual Gross Sales

Division *

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Primary Chapter *

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Do you have multiple locations? *

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If yes, how many?

Do you have a valid business license? *

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Do you have liability insurance? *

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Do you have a commercial location? *

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Do you have a sales tax license? *

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

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

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Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title *

Please add your title.

Cell Phone

Fax

Email *

Please add a valid email.

Create Account

Password

Step 4:

Billing Information

Same as Primary Contact

First Name

Last Name

Title

Cell Phone

Fax

Create Account

Password

Step 5:

Membership Package

Please select a 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 Options:

16" x 28" Aluminum Sign $25.00

Save $15 by ordering now! Reg $40 each

Comments/Questions

Payment Option

Charge my credit or debit card

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Questions or Comments? Contact Us

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