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
MM slash DD slash YYYY