Tow Truck Renewal Application Supplement - Nyc Department Of Consumer Affairs Page 3
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34. Does any individual listed in “2” or “3” hold a beneficial interest in any other tow
truck company or companies?
Yes
No
If Yes, provide the information below.
Individual’s Name
Name of Other Tow
Address
DCA License
Truck Company
Number
5. Does any individual listed in “2” or “3” have a beneficial interest in any automobile
repair shop(s) or body shop(s)?
Yes
No
If Yes, please provide the information below.
Name of Facility:
DMV Permit:
License Number:
Name of Individual:
Please enter the Federal Employer Identification Number (EIN):
If you do not have an EIN, enter individual’s Social Security Number:
Enter the New York State Sales Tax Identification Number from the Certificate of Authority:
6. My business is a participant in the following
Direct Accident Response Program (DARP)
program(s):
Rotation Tow Program (ROTOW)
None of the above
If your company is in the DARP or ROTOW programs and you store towed vehicles at an
additional location, please provide the address of the additional storage location below.
Corporation Name/Business Name:
Doing-Business-As (DBA) or Assumed Name:
Business Address (No P.O. Boxes):
I understand that falsification of any statement made herein is an offense punishable by a fine or
imprisonment or both.
________________________
_____________________________
______________
Signature
Print Name and Title
Date
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