Independent operator application form

1st row start
Last name
Street address
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2nd row start
First*
Apt #
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3rd row start
Date of birth
City
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Middle
State
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SSN/Tax ID
Zip
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Phone number
Second number
Email*
Personal Information.
Are you a United States citizen or legally authorized to work in the United States?
- Y
- N
Do you have a valid Driver’s license?
- Y
- N
** Please attach a copy of your driver license **
Accepted file types: jpg, gif, pdf, doc, docx.
Allowed file extensions: jpg, gif, pdf, doc, docx
Do you have an active TDLR Tow license?
- Y
- N
** Please attach a copy of your TDLT pocket card**
Accepted file types: jpg, gif, pdf, doc, docx.
Allowed file extensions: jpg, gif, pdf, doc, docx
license number
Company name
DBA if any
Company Address
Company TDLR license
** Please attach your company Cab Card **
Accepted file types: jpg, gif, pdf, doc, docx.
Allowed file extensions: jpg, gif, pdf, doc, docx
How many trucks do you own
What is your coverage area
( the mileage radios your company covered from your address )
Days & hours of operation
** Upload insurance certificates **
Accepted file types: jpg, gif, pdf, doc, docx.
Allowed file extensions: jpg, gif, pdf, doc, docx
Insurance Coverage:
Liability $
Cargo $
** Please attach a copy of your insurance certificate showing your coverages **
Accepted file types: jpg, gif, pdf, doc, docx.
Allowed file extensions: jpg, gif, pdf, doc, docx
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 contract.
I authorize 360 Towing Solutions 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 360 Towing Solutions.
Signature:
Date
Name
This field is for validation purposes and should be left unchanged.

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Independent operator application form

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Personal Information.

Insurance Coverage:

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