Membership Application

The IMDA welcomes your application. Any questions, please call the State Office at (217) 753-8866 or write to:
IMDA 2000 E. Cornell Springfield, IL 62703

Dealership Name: :____________________________________________
Address: ________________________________________________________
City: ___________________County:______________ State:___ Zip: ________
Contact Person/Title: ______________________________________________
Phone Number:______________________ Fax Number:__________________
Dealer #:______________________ Sales Tax #: ________________________
Franchises that you hold: __________________________________________
Your Dealership is open: ___________________________________________