"Tow Truck Company - Renewal Affirmation" - New York City

Tow Truck Company - Renewal Affirmation is a legal document that was released by the New York City Department of Consumer Affairs - a government authority operating within New York City.

Form Details:

  • Released on March 1, 2014;
  • The latest edition currently provided by the New York City Department of Consumer Affairs;
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Download "Tow Truck Company - Renewal Affirmation" - New York City

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42 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
42 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