To begin your AutoAdMax membership, please completely fill out each section and click the Submit button at the bottom of the form.

If you are unclear how to fill out a section or why information is needed click on "What's This?" for reference.

You must read and accept the "Terms and Conditions" of the Use Agreement before this form can be submitted.   Your information will be processed immediately and a Sales Representative will contact you to verify your Payment Information.  

If you need assistance, please call 888.222.3220.

( * = Required )

Dealership Information Group Name(s) ( if applicable )   Name of Dealership* Dealership Address*   City*     State*     Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming     Zip*     Phone* ( ) - Fax* ( ) - Market Area 1. 2. 3. 4. 5.

Primary Contact/User Information Note: Selecting "Email" allows that person to receive correspondence from AutoAdMax. This includes emails regarding responses to database requests, program updates, offline notification, invoices and any other news from AutoAdMax.      Name*   Title*   Phone*   Fax*   E-mail*   Password* (4-10 characters)   Access*   Email      - Select One - Full Access Limited Access                    Additional Contact/User Information Enter Additional Users at your dealership who will need to logon to AutoAdMax.      Name*   Title*   Phone*   Fax*   E-mail*   Password* (4-10 characters)   Access*   Email 1. - Select One - Full Access Limited Access 2. - Select One - Full Access Limited Access 3. - Select One - Full Access Limited Access 4. - Select One - Full Access Limited Access 5. - Select One - Full Access Limited Access 6. - Select One - Full Access Limited Access

Franchise Information Select from the list each franchise your dealership represents. ACURA ASTON MARTIN AUDI BENTLEY BMW BUICK CADILLAC CHEVROLET CHRYSLER DAEWOO DODGE FERRARI FIAT FISKER FORD GMC HONDA HUMMER HYUNDAI INFINITI ISUZU JAGUAR JEEP KIA LAMBORGHINI LAND ROVER LEXUS LINCOLN LOTUS MASERATI MAYBACH MAZDA MERCEDES-BENZ MERCURY MINI MITSUBISHI NISSAN OLDSMOBILE PANOZ PLYMOUTH PONTIAC PORSCHE RAM RANGE ROVER ROLLS-ROYCE SAAB SATURN SCION SMART SUBARU SUZUKI TESLA TOYOTA VOLKSWAGEN VOLVO

Other Dealerships to Monitor    Name of Dealership  City 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

Payment Information   AutoAdMax Custom Account Set-Up Fee - $2800 This one-time fee includes the creation of your dealership's master Survey form, programming of your dealership's user interface, market research for your dealership's customized database. $          AutoAdMax Monthly Use Fee - NEW ACCOUNTS Select one of the following payment options:      OPTION 1: CREDIT CARD Pay by credit card for initial 3 months of use - $1125 Your credit card will be charged for the Total Initial Investment calculated below. Following the initial 3-months your AutoAdMax account automatically transitions to month-to-month and your dealership will be charged $375 on the first day of each month. $      OPTION 2: INVOICE Pay by check for initial 3 months of use - $1125 Your dealership will be invoiced for the Total Initial Investment calculated below. Following the initial 3-months your AutoAdMax account automatically transitions to month-to-month and your dealership will be invoiced $375 on the first day of each month. $    AutoAdMax Monthly Use Fee - GROUP ACCOUNTS Select one of the following payment options:   OPTION 3: CREDIT CARD Pay Monthly by credit card - $375 Your credit card will be charged for the Total Initial Investment calculated below. This is a month-to-month agreement. Your dealership will be charged $375 on the first day of each month. $      OPTION 4: INVOICE Pay Monthly by check - $375 Your dealership will be invoiced for the Total Initial Investment calculated below. This is a month-to-month agreement. Your dealership will be invoiced $375 on the first day of each month. $      AAM Authorization Code:           TOTAL INITIAL INVESTMENT $        CANCELATION POLICY: After the initial 3 month period your AutoAdMax account can be canceled at any time. To cancel your AutoadMax account send an email 30 days in advance to: support@autoadmax.com **Account Activation Process: To ensure that an accurate and organized system is established, the information entered on this Sign-up Form will be processed through Research & Development, Programming and Design. Within 5 business days after payment has been received, your account's Primary Contact will be emailed notification that your account has been activated and the information needed to begin collecting and entering Surveys.    Credit Card Information Card Holder's Name Credit Card Number  Card Type Visa MasterCard Amer. Ex. Discover    Expiration  Month 01 02 03 04 05 06 07 08 09 10 11 12  / Year 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 3-digit security code                 For Visa and MasterCard users. The last 3 numbers of the 7 digit number in the signature line on the back of your card.     I have read and accepted the terms and conditions of the Use Agreement (here). ( Must be checked for Sign-in Form to be submitted.)