Personal Information
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First Name
Last Name
Facility Name
Address
Apt/Unit
City
State
Select State
CT
MA
NH
NJ
NY
RI
Zip Code
Email
Phone Number (digits only)
Cell Phone (digits only)
Website URL
Years in Business
Current services offered (indicate all that apply)
Towing
Light Service
Repair
Body
Locksmith
Current Vehicle Count
Flatbeds
Wreckers/Wheel Lift
Light Service Only
Tow Capabilities
Light
Medium
Heavy Duty
Motorcycle
Low Clearance
Dollies
Current Staff
Tow Technicians
Light Service Only Technicians
Shop Mechanics
For road services, what towns/cities are you interested in serving?
Affiliations (such as other motor clubs, state police, professional associations, automotive companies, etc.)
Services You Would Like to Provide (check all that apply)
Towing
Light Service
Approved Auto Repair
Car Battery
Locksmith
Select Federal Tax Classification
Individual/Sole Proprietor
Single Member LLC
S Corporation
Trust/Estate
C Corporation
Partnership
Limited Liability Company (LLC)
Other
24/7 Operations
Yes
No
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