National Automobile Club, Peace of Mind, Mile after Mile, since 1924
Who we are

Service Provider Application
Please complete and submit the application below for appointment as an official Service Contractor. If you have any questions, please call the NAC at 1-800-622-2136 or email us at ers@thenac.com.

CONTACT INFORMATION
 
* NAME: * EMAIL:
* ADDRESS: * CITY:
*STATE: * ZIP:
* PHONE: FAX:
 
COMPANY INFORMATION
 
* COMPANY NAME:

* CORPORATE TAX ID or
SOCIAL SECURITY NUMBER:

INSURANCE CARRIER:
NUMBER OF YEARS IN BUSINESS:
TYPE OF BUSINESS:

NATURE OF BUSINESS:

OPEN 24/7:
YES NO
IF NO, PLEASE LIST YOUR HOURS:
 
NUMBER OF DISPATCHERS:
NUMBER OF TOW OPERTATORS:
NUMBER OF SERVICE OPERTATORS:

DO YOU HAVE:


LIGHT DUTY CAPABILITIES:
YES NO
MEDIUM DUTY CAPABILITIES:
YES NO
HEAVY DUTY CAPABILITIES:
YES NO
LOW CLEARANCE CAPABILITIES:
YES NO
 

ARE YOU CURRENTLY ON ROTATION
WITH ANY POLICE AGENCIES?:


HIGHWAY PATROL:
YES NO
LOCAL PD:
YES NO
SHERIFF:
YES NO
TOTAL NUMBER OF TOW VEHICLES:
SLING/COMBO:
WHEEL LIFTS:
FLATBEDS:
SERVICE VEHICLES:
4X4:
PLEASE LIST MAKE, YEAR, RATING, AND CRANE CAPACITY FOR EACH VEHICLE
AND ADD ANY ADDITIONAL COMMENTS:
 

 
 
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