Modern Auto Protection LOGODEALER ENROLLMENT FORM

Dealership Personnel

Enter All That Apply.  

Dealership Payments

Dealership Systems

Dealership Profit

Agent Information

Other Documentation Required
Submitting this Dealer Enrollment Form will allow the Modern Auto Protection administrator to begin the enrollment process. However, the enrollment process cannot be completed until the dealer submits a signed and executed Dealer Producer Agreement and W-9.

Administrator

American Auto Shield, LLC 1597 Cole Boulevard Suite 200 Lakewood CO 80401 Phone 800-531-1925 X2297

• Email: info@modernautoprotection.com • Fax: 800-728-5065