SECTION 1 - APPLICANT INFORMATION

Wrecker Class
Credit cards accepted?

SECTION 2 - DRIVER INFORMATION

Driver Information
Driver's Licence Number
Driver's Name
Driver's Class
Driver's State
 

SECTION 3 - INSURANCE COVERAGE

Include Certificate of Insurance. If unable to upload, mail to:
60 Court Plaza
Asheville NC, 28801
Attn: Professional Standards
Max. file size: 128 MB.

SECTION 4 - IDENTIFY WRECKERS

Identify Wreckers(Required)
Make
Model
Vin
Tag
Class
 

SECTION 5 - PROPOSED FEES

Certification

NOTICE:
Proposed rates for all equipment usage should include the cost of an operator, operating expenses, and the cost to transport the equipment to and from the scene.
Clear Signature