Provider Application

General

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Questions

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Services

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Equipment

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Coverage

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Documents

General Information

Legal Business Name

Doing Business As (dba)

Business Phone

Email Address

Business Fax

Website Address

Business Address (for coverage search)

City

State/Province

Zip/Postal Code

Mailing Address (if different)

City

State/Province

Zip/Postal Code

Contact and Other Information

Owner Name

Owner Phone

Owner Cell

Manager Name

Manager Phone

Manager Cell

Dispatch Phone

Tax ID or GST #

Bus. Lic./Permit #

Years in Business

Questions

Yes

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?

Do you have a repair facility?

Do you sell tires?

Do you sell batteries?

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 provide 24/7 service?

Do you employ an answering service?

What method of payment will you accept from our members?

AMEX

Visa

Fleet Cards

Discover

MasterCard

ATM/Debit

Check

Cash

What type of vehicles do you tow?

Light Duty

Medium Duty

Heavy Duty

Super Duty

Motorcycles

Services

Please check services that you provide:

Jump Start

Lockout

Tire Change

Tire Inflation

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

Remanufactured Replacement

T&W Cosmetic and Straightening

T&W Straightening Repair

Tire & Wheel Cosmetic Repair

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

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

Equipment

Please enter number of vehicles for each category:

All Terrain

Electric Vehicle

Fifth Wheel

Gooseneck

Landoll / Lowboy

Light Service Unit

Motorcycle Carrier

Trailer

Wheel Lift

Ball Hitch

Enclosed Carrier

Flatbed

Heavy Duty

Light Duty

Medium Duty

Super Duty

Water Vessel

Coverage

Right-click on Selected ZIPs, select all, copy, then paste below:

Zipcodes You Service

The Zipcodes You Service will develop an area of total coverage for your company. Your rate negotiations with a Regional Manager will decide your primary area within these zips that you can cover under a flat rate.

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