Sign Up


Please fill in the below form to sign up for the dealership program.

Company Name *
 
Primary Contact *
 
Secondary Contact
Address *
 
City *
 
State *
 
Zip *
    
Company Phone *
xxx-xxx-xxxx
Ext:  
Alternate Phone
xxx-xxx-xxxx
Ext:  
Fax
xxx-xxx-xxxx
 
Email *
 
Alternate email
My location is a (check all that apply):
Buy Here Pay Here
 Car Dealership
 Check Cashing Store
 Collections Agency
 Insurance Company
 Manufactured / Mobile Home
 New Car / Franchise Dealer
 Other
 Pay Day Advance / Cash Loan
Explain:
How many locations do you have? *
Who is your DMS (Dealer Management Software) provider? *


Other:
 
Who is your Inventory Manager? *
 
What are your business hours? *
 
How did you hear about us? *


Other:
 
Please select one of the following regarding On Site issued Debit Cards and On Site Check Printing:
I would like Prepaid VISA Cards and Checks
I would like Checks ONLY
I would like Prepaid Visa Cards ONLY
Please list any comments or questions you would like to have answered:
If you know of any other companies or locations that may want to participate in our Tax Max Marketing program, please provide their contact information below.
Dealership:
Phone number:
xxx-xxx-xxxx
Contact: