NSD Dispatch
Independent Service Provider Application
Legal Business Name:
Doing Business As (d/b/a):
Business Address:
City: State / Province:
Zip / Postal Code:    
Business Phone: 555-555-5555 Business Fax: 555-555-5555
Email Address: Website Address:
Click for Multiple Service Locations. (If dispatch phone number is different, please submit a new application)

Mailing Address
(if different from above):
City: State / Province:
Zip / Postal Code:    

Owner's Name:    
Owner's Phone: 555-555-5555 Owner's Cell: 555-555-5555
Manager's Name: Manager's Cell: 555-555-5555
Manager's Phone: 555-555-5555 Business License/Permit #:
Tax ID or GST Number: Yrs In Business:

  Yes No
Do you digitally dispatch?
Do you perform background checks on all drivers?
Do you comply with all state and federal immigration
laws mandated for the towing industry?
Are drivers uniformed?
Are you a member of the Better Business Bureau?
Are you a member of any industry associations?
Are you providing service for any other motor clubs?
Do you do any Police, Highway patrol, or sheriffs calls?
  Yes No
Do you have a repair facility?
  Yes No
Do you sell tires?
  Yes No
Do you sell batteries?
  Yes No
Do you have a storage lot?
Are you capable of Accident Scene Towing?
Are you capable of any Secondary Accident Towing
(after the accident, yard to yard, shop to shop etc)?
Do you accept Fax Dispatch?
Do you employ an answering service?
What method of payment will you accept from our members?
American Express
MasterCard

Visa
ATM/Debit

Fleet Cards
Personal check

Discover
Cash

Do you tow:
Light Duty
Medium Duty

Heavy Duty
Super Duty

Motorcycles
Roadside Services:
Please check all services that apply:
Jump Start Lockout
Tire Change Tire Inflation
Fuel Delivery includes GAS Light Duty Unleaded Fuel Delivery
Light Duty Diesel Fuel Delivery Flat Bed Towing
Vehicle Unloading Service Lowboy Trailer
Winching Locksmith
Mobile Battery Sale and Install Mobile Tire Sale and Install
Paintless Dent Repair Paintless Dent Repair 1
Paintless Dent Repair 2 Paintless Dent Repair 3
Paintless Dent Repair 4 Plus Remanufactured Replacement 1
Remanufactured Replacement 2 Remanufactured Replacement 3
Remanufactured Replacement 4 T&W Cosmetic and Straightening 1
T&W Cosmetic and Straightening 4 T&W Mount and Balance
T&W Polished - Onsite or Reman T&W Polished Onsite
T&W Straightening Repair 1 T&W Straightening Repair 3
T&W Straightening Repair 4 Tire & Wheel Cosmetic Repair 1
Tire & Wheel Cosmetic Repair 2 Tire & Wheel Cosmetic Repair 3
Tire & Wheel Cosmetic Repair 4 Tire & Wheel Inspection
Windshield Repair Motorcycle Jump Start
Medium Duty Tire Change Medium Duty Winching
Medium Duty Jump Start Medium Duty Lockout
Heavy Duty Tire Change Ball Hitch Towing
Fifth Wheel Towing Gooseneck Towing
Heavy Duty Winching Master Certified RV Tech
Tow Store Tow Store Load
Heavy Duty Jump Start Heavy Duty Lockout
Super Duty Tire Change Super Duty Winching
Super Duty Jump Start Super Duty Lockout
Low Clearance Tow Medium Duty Diesel Fuel Delivery
Heavy Duty Diesel Fuel Delivery Super Duty Diesel Fuel Delivery
Medium Duty Unleaded Fuel Delivery Heavy Duty Unleaded Fuel Delivery
Mobile Mechanic Super Duty Unleaded Fuel Delivery
Luxury Towing Two way tow
Water Vessel Towing Electric Vehicle Charging
All Terrain Towing Exotic Towing
Light Duty Recovery Medium Duty Recovery
Heavy Duty Recovery Super Duty Recovery
Motorcycle Recovery
  Yes No
Do you provide 24 hour 7 day a week service?
Equipment (number of vehicles in each category):
All Terrain
Ball Hitch

Electric Vehicle
Enclosed Carrier

Fifth Wheel
Flatbed

Gooseneck
Heavy Duty

Landoll / Lowboy
Light Duty

Light Service Unit
Medium Duty

Motorcycle Carrier
Super Duty

Trailer
Water Vessel

Wheel Lift
Please enter a distance from your base of operation, in which you can provide service within a 45 min ETA, under normal weather conditions.
Miles (Maximum 100 miles)
Enter zipcodes that you service (eg: 33414,33415,33417)
NOTE: If you have any concerns, fill in the box
below and a Regional Manager will contact you to discuss and rectify.


For any questions or concerns regarding your application or status with NSD please contact our network support team at 1-888-362-7805.