Application to access UCSA Dealer Information

Fill out the form below to register to enter the General Dealers area. All required fields must have valid values. Once you press the submit button and all the fields are valid, a verification page will be displayed. If you provide an email address, you will also receive an email confirmation. Once we receive your registration request, someone in our staff with satisfy themselves that you are a UCSA dealer and then they will active your account. When they activate your account, you will receive an email to that affect.

Fill out the information shown below. Fields in bold are required.

Dealer ID: enter your UCSA Dealer Number

User ID: User ID you will use to access the member back-office area

Password: Password you will use to access the member back-office area

Company Name:

First/Last Name:

Home Phone: (817-333-5555)

Work Phone: (817-333-5555 or 817-333-5555x1234)

Other Phone: (cell 817-333-5555)

Fax: (817-333-5555)

Email address: (name@domainname.com)

Mail Street:

Mail Street2:

Mail City:

Mail State/Prov: Zip/Postal Code: (US 12345 or 12345-1234, Canada A1B 2C3)

Country:

Dealer ID:	enter your UCSA Dealer Number
User ID:	User ID you will use to access the member back-office area
Password:	Password you will use to access the member back-office area
Company Name:
First/Last Name:
Home Phone:	(817-333-5555)
Work Phone:	(817-333-5555 or 817-333-5555x1234)
Other Phone:	(cell 817-333-5555)
Fax:	(817-333-5555)
Email address:	(name@domainname.com)
Mail Street:
Mail Street2:
Mail City:
Mail State/Prov:	Zip/Postal Code: (US 12345 or 12345-1234, Canada A1B 2C3)
Country: