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:
Hybrid Vehicle Jump Start 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 2
T&W Cosmetic and Straightening 3 T&W Cosmetic and Straightening 4
T&W Straightening Repair 1 T&W Straightening Repair 2
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 Mobile Battery Installation
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.