Canadian Customers: Click here for the
Canadian registration form
.
Recycler Yard Information:
Formal Company Name:
Billing Information
Billing Address:
Shipping Information
Shipping Address:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
ZIP Code:
Contact Information
Administrative Contact:
Computer Tech Contact:
Phone #1:
Phone #2:
Fax:
Administrative email:
Existing Web Site Name
http://
Your Business Hours:
Monday - Friday:
Open
---
1
2
3
4
5
6
7
8
9
10
11
12
---
00
15
30
45
---
AM
PM
Close
---
1
2
3
4
5
6
7
8
9
10
11
12
---
00
15
30
45
---
PM
AM
Saturday:
Open
---
1
2
3
4
5
6
7
8
9
10
11
12
---
00
15
30
45
---
AM
PM
Close
---
1
2
3
4
5
6
7
8
9
10
11
12
---
00
15
30
45
---
PM
AM
Time Zone
EST
CST
MST
PST
AST
HAST
Memberships:
Check all that apply
:
ARA
®
CARS
®
Gold Seal
®
URG
®
URG6000
®
URG7000
®
URG8000
®
State organization name:
Local organization name:
Other organization name:
Please publish the business data above on Car-Part.com
Yes
No
Parts Ordering Information:
Company name to appear with part matches*:
Phone number to appear with part matches:
Email address to appear with part matches*:
Do you want to receive emails for parts not in stock?
If so, enter the email address where you want to receive them:
No
Yes
Current Inventory Management System:
Hollander
®
AIM
®
iSoft
®
Powerlink
®
PowerlinkII
®
No IMS
* Yard Number required for the following inventory management systems
Pinnacle
®
FastParts
®
Yard Number:
Checkmate
®
Checkmate Jr.
Checkmate Classic
Checkmate Cache
Services Order Form:
Web site domain name setup
$100 per name for 2 years
$150 per name for 10 years
What Web site domain name do you have or want?*
(Subject to availability):
http://
Additional Web site domain names:
(Optional, $100 per name for 2 years)
Web server Setup
(Required)
$150 per site (REQUIRED)
A. Host my Web site with inventory
$125/month
Billed monthly
--or--
$1340/year
Paid after set-up
($160 discount)
B. I want my Web site hosted by someone else and only want an inventory search page added to my Web site
$125/month
Billed monthly
--or--
$1340/year
Paid after set-up
($160 discount)
Do you need Web site development services?
Yes -- $100 and up
No
Data filters and/or wholesale page
$5/month each
(Display wholesale price to all)
Email accounts
Number of accounts:
One account free if Car-Part.com hosts my site.
$3 per month for each additional account.
Email account names
Software and misc.:
$100 ProComm
®
$40 Norton Anti-Virus
®***
$20 A/B Switch
Miscellaneous Information:
1. Do you currently have a PC with Internet access connected to a Hollander or Checkmate system?
Yes
No
2. If no, will you be:
replacing a terminal PC -- or --
adding another PC or workstation
3. Will you be using a split screen function on your new workstation?
Yes
No
4. If you are adding a PC for another workstation, what length of cable will be needed to connect the Hollander or Checkmate computer to the Internet?
6'
10'
25'
50'
Publication Information:
Publish my inventory with mileage on Car-Part.com (Free with Web site or inventory search)
FREE -- Publish my inventory on all consolidated sites
of organizations hosted by Car-Part.com that I belong to.
FREE -- Allow my inventory information to be forwarded to other companies
to be available for estimates and/or audits of estimates.
A. Do not publish my inventory on any trading group sites unless I consent in writing.
-- OR --
B. FREE - Publish my inventory on trading group sites except for the following:
Publish price for Trading Partners searches:
Retail-No Charge
Wholesale--($5/month filter charge)
To order a custom trading group for yourself, fill out the
Trading Group Site Agreement
($45/month and $65 set-up fee)
To order a custom brokerage page for yourself, fill out the
Brokerage Page Agreement
All dollar values on this and any other Car-Part.com forms are US dollars unless noted otherwise.
How did you become aware of our services?
(Check all that apply)
Magazine
Trade show
Friend
Direct mail
Internet
Salesperson:
Roger
Bryan
Drew
Becky
How many employees do you have?
How many Internet-accessible screens do you have?
Sales Contact Information
Phone Number
: 859-344-1925
Fax Number
: 859-344-1954
Car-Part.com's
Terms and Conditions for Recycler Customers
are incorporated in this Agreement,
and by signing this form (if registration is in writing) or clicking the "Register Me" button (if registration is electronic),
I am agreeing to be bound by that document. A faxed signature is considered an original on this form.
_______________________________
Signature
_______________________________
Print Name
***
NORTON 2002 ANTIVIRUS
®
software is
required
on your upload PC. You are also required to keep the virus definitions up to date
* Required field
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