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Application

General Information

Company Name
Facility Address
City
State
Zip
Mailing Address (if different)
City
State
Zip
Phone
Fax
Email Address
Contact Person
Owner (if different)
Desired Territory
City
State
Form of Business: Sole Ownership Partnership Corporation Francise

Business/Facility Information

In what year was your business established
How long has your business been under the current ownership/management
How long have you been at your current location
24-hour coverage
Do you have an overnight storage facility
If yes, what is the vehicle capacity

Dispatching

How many phone lines do you operate
Number of dispatchers
24-hour live dispatching
Software managed dispatching enabled
Mobile Phone dispatching
If yes, is this GPS
Answering Service
2-way radio contact
Other electronic driver interaction

Fleet

Total Vehicles in fleet
Number of Road Service vehicles
Number of light duty flatbeds
Wheel lifts
Number of medium duty towing vehicles
Number of heavy duty towing vehicles
Vehicle replacement frequency

Driver Information

Number of drivers
Average driver tenure
Number of drivers under 25
Do you perform criminal background checks
Frequency
Do you perform DMV background checks
Frequency
Do you perform drug testing
Frequency
Do you certify using external training
Do you certify using internal training
Do you provide uniforms with your company logo
Do you offer your employees major medical insurance
Limited Medical Insurance

Services You Provide

: Low clearance trucks Tire Change Service Gojacks Accident/Recovery Low Boy Dollies Fifth Wheel Locksmith Lockout Service Fuel Delivery Winching

For Medium and Heavy duty vehicles

Tire Change: Medium Heavy
Tire Repair: Medium Heavy
Mobile Mechanic: Medium Heavy
Road service: Medium Heavy
Tow: Medium Heavy
Winching: Medium Heavy

Insurance Information

What are your current levels ($ amount) of insurance coverage

Commercial General Liability
Commercial Auto Liability
Garage Keepers On Hook/Cargo
Garage Keepers Coverage
Workers Compensation

References

Name of Company
Contact Person
Address
City
State
Zip
Telephone
Number of years in providing service to this customer

Name of Company
Contact Person
Address
City
State
Zip
Telephone
Number of years in providing service to this customer

Add Reference

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