Registration Intent form

Alternative Contact/Manager (if different)

Shipping Address (if different than above)

Retail Service Support Program (RSSP) Affiliation

Please provide your program affiliation information. (Franchise or Corporate Head Office information)

Select one of the following Programs:

OPTIONAL - Cancel from an ACDelco Program if currently a member

Noted Independent Service Centre business is currently enrolled in an ACDelco Program and wishes to cancel in order to register for the ACDelco Professional Service Centre member in the Retail Service Support Program or the ACDelco Retail Support Program. By clicking YES, you are agreeing to cancel from your current ACDelco program membership, as of this date, and proceed registering for the ACDelco PSC member in RSSP Program or ACDelco RSSP.

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