Application for Service Vendors Please complete the application below to apply to become one of our trusted service vendors.Step 1Service Provider Application FormLegal Business Name *Website *Street Address *Street Address 2City *State/Province *ZIP / Postal Code *Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweFirst Name *Last Name *Phone Number *Alternate NumberFaxEmail Address *Service QuestionsDo you own a service truck, van or pick up? *YesNoDo you own a full diesel mechanical shop? *YesNoIf you own a shop, are you able to get a semi in the doors?YesNoIf you own a shop, can our customers drop their equipment at your location over night? *YesNoDo you do tire calls? *YesNoDo you carry tires? *YesNoDo you have a compressor on your mobile unit? *YesNoDo you work night calls? *YesNoDo you work weekends? *YesNoDo you take credit cards? *YesNoHow many employees do you have? *How many service vehicles do you have? *How many active service mechanics do you currently have? *How long has your team been diesel mechanics? (please list the number of years per mechanic) *What hours do you operate? (list all your operating days and hours below) *Services You ProvideMobile Repair *YesNoTire Repair *YesNoTire Replacement *YesNoFlat Tire Change *YesNoLock Outs *YesNoFuel | Fluid Delivery *YesNoPull | Jump Starts *YesNoParts Delivery *YesNoWinching | Extraction *YesNoDo you carry an air compressor? *YesNoDo you offer Heavy Duty towing? *YesNoFlat Call Out Fees (if any, enter $0 if none)Mobile Repair *USDTire Repair *USDTire Replacement *USDFlat Tire Change *USDLock Outs *USDFuel | Fluid Delivery *USDPull | Jump Starts *USDParts Delivery *USDWinching | Extraction *USDTowing *USDHourly Labor Rate (if any, enter $0 if none)Mobile Repair *USDTire Repair *USDTire Replacement *USDFlat Tire Change *USDLock Outs *USDFuel | Fluid Delivery *USDPull | Jump Starts *USDParts Delivery *USDWinching | Extraction *USDTowing *USDTowing (Mileage Rate) *USDLight Duty Towing ServicesTowing *YesNoAccident | Towing *YesNoSecondary | Towing *YesNoTransport Services *YesNoWinching *YesNoMedium Duty Towing ServicesTowing *YesNoAccident | Towing *YesNoSecondary | Towing *YesNoTransport Services *YesNoWinching *YesNoHeavy Duty Towing ServicesTowing *YesNoAccident | Towing *YesNoSecondary | Towing *YesNoTransport Services *YesNoWinching *YesNoSuper Duty Towing ServicesTowing *YesNoAccident | Towing *YesNoSecondary | Towing *YesNoTransport Services *YesNoWinching *YesNoLight Duty Road ServicesJumpstart *YesNoFuel | Fluid Delivery *YesNoLockout *YesNoLocksmith *YesNoTire Change *YesNoBattery Delivery & Installation *YesNoMotorcycle ServicesJumpstart *YesNoFuel | Fluid Delivery *YesNoLockout *YesNoLocksmith *YesNoTire Change *YesNoBattery Delivery & Installation *YesNoMedium Duty Road ServicesJumpstart *YesNoFuel | Fluid Delivery *YesNoLockout *YesNoLocksmith *YesNoTire Change *YesNoBattery Delivery & Installation *YesNoHeavy Duty Road ServicesJumpstart *YesNoFuel | Fluid Delivery *YesNoLockout *YesNoLocksmith *YesNoTire Change *YesNoBattery Delivery & Installation *YesNoSuper Duty Road ServicesJumpstart *YesNoFuel | Fluid Delivery *YesNoLockout *YesNoLocksmith *YesNoTire Change *YesNoBattery Delivery & Installation *YesNoIn Shop RepairsMechanical Repair *YesNoBody Repair *YesNoTransmission Repair *YesNoMobile RepairsMechanical Repair *YesNoBody Repair *YesNoTransmission Repair *YesNoStorage FacilitiesMechanical Repair *YesNoBody Repair *YesNoTransmission Repair *YesNoEquipment: Indicate below how many of the following you haveNumber of Tow Trucks *Number of Wheel Lifts *Number of Flatbeds | Rollbacks *Number of Low Clearance *Number of Medium Duty *Number of Heavy Duty *Number of Light Duty *Number of Fleet Vehicles *Number of Low Clearance *Number of Mobile E-Charging *Number of Vehicle Carriers *Number of 2-Car *Number of 3-Car *Number of more than 3-Car *Number of Landoll | Lowboy *Number of Dollies *Other Equipment (please specify)Questions | CommentsStep 2Please upload your photos and descriptions of each vehicle.Upload PhotosDrag and Drop (or) Choose FilesSubmit
