STATEWIDE FRANCHISE YOU CAN TRUST

 

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1 (877) 836-4869

 

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Franchisee

Personal Information












Company / Business Information

Are you a United States citizen or legally authorized to work in the United States?

Do you have a valid Driver’s license?




Please attach a copy of your driver license. Accepted file types .doc | .docx | .pdf | .jpg | .jpeg, max file size 2MB

Do you have an active Tow Permit?



Please attach a copy of your Tow Permit pocket card. Accepted file types .doc | .docx | .pdf | .jpg | .jpeg, max file size 2MB






Please attach your company Tow License. Accepted file types .doc | .docx | .pdf | .jpg | .jpeg, max file size 2MB


Please write a number


What is the mileage radius your company coveres from your address?


Example: Mo-Fr 08:00-20:00. Please separete with , or new line

Insurance Coverage:





Please attach a copy of your insurance certificate showing your coverages. Accepted file types .doc | .docx | .pdf | .jpg | .jpeg, max file size 2MB

For your information, all our calls to and from our call center are being monitored and recorded For training and security purposes.

I represent that the above information, and any other information I may be required to provide, is complete and accurate and any misstatement or omission may result in rejection of my application or termination of the contract.
I authorize 10-4 Tow to conduct, at its discretion an investigative consumer report concerning my character, general reputation, personal characteristics and mode of living. Upon written request, additional disclosure concerning the complete nature and scope of the investigation will be provided.
If I am contracted, I agree to comply with the policies, procedures, guidelines and standards of conduct of 10-4 Tow .