Tow Truck Company - Renewal Affirmation - Nyc Department Of Consumer Affairs
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142 Broadway
TOW TRUCK COMPANY - RENEWAL
New York, NY 10004
AFFIRMATION
Dial 311
(212-NEW-YORK)
Business Name:
nyc.gov/consumers
Doing-Business-As (DBA)/Trade Name:
DCA License Number:
Yes*
Will the business tow vehicles from private
No
properties?
*If Yes, you must also submit an accurate,
complete, and current list of private
properties from which you tow vehicles
and a copy of such contract(s). Note: Any
changes to submitted list (e.g., name or
address of private property owner) must be
sent to DCA within 15 days of such
change.
American Express
Please select the credit card(s) your business
Diners Club
accepts:
Discover Card
MasterCard
Visa
Other. Please specify: _________
ROTOW Program Participants:
Saturday
Your premises must be open for redemption of
Sunday
vehicles from 9 a.m. to 4 p.m., Monday
through Friday. Please indicate if your
premises will be open during these hours on:
I affirm the following:
I am authorized to complete and submit this affirmation on behalf of the Tow
Truck Company named above.
I have knowledge of and authority with regard to the policies and practices of the
Tow Truck Company named above.
Tow Truck Company named above accepts from any vehicle owner and/or
operator payment by credit card for all fees incurred, in accordance with generally
accepted business practices.
I understand that falsification of any statement made herein is an offense
punishable by a fine or imprisonment or both.
__________________________________
__________________________________
Signature
Title/Position
__________________________________
__________________________________
Print Full Name
Date
Updated 03/2014
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