Vendor Application


Please fill out all information below, once the form is completed a copy will be sent you via email with further instructions.

Business Information


Business Name:

Owners Name:

Physical Location Address:

Mailing Address:

City:

State/Province:

Please select an item.

Zip/Postal Code:

Exceeded maximum number of characters.

Cities that you service: (Seperate by commas)

Zip codes that you service: (Seperate by commas)

Contact Person and Title:

Business Phone:

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Fax Number:

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Alt Phone: (Optional)

( ) -

Email Address:


Insurance Information


Insurance Company:

Agents Name:

Agency Full Address:

Agency Phone Number:

( ) -

Policy Number(s): (Seperate by commas)


Service Data

Phone Numbers and Hours available

Day

( ) -

Monday to Friday

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Saturday

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Sunday

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Night

( ) -

Monday to Friday

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Saturday

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Sunday

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Maximum Radius of Service: miles

Recognized Holidays:

Is your business open 24 hours?
Please make a selection.


Service Available

Please check all that apply:


Equipment

Number of vehicles insured to tow for motor club. (Insurance Certificate should reflect the number of vehicles specified below.)

Dollies

Wheel Lift

Equipped to handle motorcycles

Flatbed

Semi

Equipped to handle RV's

Winch

Service Vehicle

Equipped to handle Light Duty

Tow

Misc.

Equipped to handle Medium Duty

       

Equipped to handle Heavy Duty


Rates (Light and Medium)

Please round service charges to a whole number.

GOA Fee: $ after the first 30 minutes. (Auto Knight does not pay mileage on GOA)

Service Call Rate     Day Rate: $     Night Rate: $

Free miles included in service charge: (Typical # of miles - 15 free in route)

Cost per additional mile $ .

Towing Rate (Light)            Day Rate: $      Night Rate: $

Towing Rate (Medium)            Day Rate: $      Night Rate: $

Free in route miles:

In route mile cost: $ .

 

Free loaded miles:

Cost per additional mile: $ .

 

Rates (Heavy)

Please round service charges to a whole number.

Service Call Rate     Day Rate: $     Night Rate: $

Free miles included in service charge: (Typical # of miles - 15 free in route)

Service call out fee:

Cost per additional mile $ .

Fuel Surcharge? Yes or No? Please select an item. $ . If no, please put zeros.

Other:

Towing Rate            Day Rate: $      Night Rate: $

Free in route miles:

In route mile cost: $ .

 

Free loaded miles:

Cost per additional mile: $ .

Drive Shaft: $

Fuel Surcharge? Yes or No? $ . If no , please put zeros.

Other:


Rates (Misc)

Dollie Fee: $

Air Compressor Fee: $

Winching: (describe policy)

Extra cost for flatbed if any $ If no, please put one zero


Thank you for submitting your bid to Auto Knight Motor Club. Existing rates will apply unless renegotiated by both parties. Please allow 7 days for processing.

I/we hereby consent to the use by Auto Knight Motor Club of my/our signature(s), if provided. I/we agree to inform Auto Knight Motor Club promptly of any change in my/our email address. I/we understand that my/our electronic signatures on these documents may not be invalidated on the basis that the signatures were electronically obtained.

If an incorrect signature or information is given this may result in an automatic denial of your application.

Signed:    Title:    Date: