Tow Truck Company Roster Of Employees Form - Nyc Department Of Consumer Affairs

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42 Broadway
TOW TRUCK COMPANY
New York, NY 10004
ROSTER OF EMPLOYEES FORM
Dial 311
(212-NEW-YORK)
nyc.gov/consumers
Tow Truck Company:
_____________________________________
Name of License Applicant
Are you applying for a Tow Truck Company License
 Yes
 No
and a Tow Truck Driver License?
If you are not applying for both licenses, at least one person in your business
must hold a current and valid Tow Truck Driver license issued by the
Department of Consumer Affairs (e.g., sole proprietor, general partner,
director, corporate officer, shareholder owning 10% or more of company
stock, or employee).
Please complete required information below for your licensed drivers. Attach
additional papers as necessary.
Driver’s Name
DCA License Number
_______________________________
___________________________
Signature
Print Name
_______________________________
___________________________
Title/Position (if any)
Date

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