THE SEMI-TOWING SERVICE COMPANY, LLC
34954 LBJ FREEWAY
Dallas, Texas 75241
Phone: (972) 757-5489
Facsimile: 1-888-700-0198
E-Mail: info@thesemi-towingservice.com
In order to establish an account and/or provide your method of payment for services, please fill in the following
information:
Company Information
Company name EIN Number:
Corporation LLC Sole Proprietorship Partnership Other 
Owner's name   Social Security Number Fed/ID Number
MC#:
USDOT#:
D&B Dunns #: SCAC:
Business Address: Mailing Address:
Contact Name: Telephone Number: ext:
E-mail Address: Fax Number:
Nature of Business: No. of Years in Business:

No. of Trucks
No. of Trailers
No. of Tractors
No. of Fleet Equipment:
No. of Other Products:  
Type of Other Products:

Type of Trucks
Type of Trailers
Type of Tractors
Type of Fleet Equipment:
No. of Other Products:     
Type of Other Products:  

Do you require a purchase order? Yes No If yes, contact person:

Authorized persons:

I , an Authorized Agent, hereby authorize, The Semi-Towing Services Company, LLC, its Agent and/or authorized personnel to investigate the credit history for this application in order to establish a credit trade account. This account, upon approval, will allow credit services to be provided to our company in accordance to the terms and conditions set forth and approved by The Semi-Towing Services Company, LLC. Upon approval of this application for account, The Semi-Towing Services Company, LLC will provide the Terms and Conditions that will govern the amount of credit approved for the credit trade account. I hereby agree to provide the information referenced below which is part of this account application process.
Bank References
Name and Address of Bank: Account No.:
Contact Person: Telephone Number: ext:
Fax:
Title/Position: E-mail Address:
Bank References #2 
Name and Address of Bank: Account No.:
Contact Person: Telephone Number: ext:
Fax:
Title/Position: E-mail Address:
Local Trade References
Company Name: Address:
Contact Person:
Telephone Number: ext Fax Number:
E-mail Address:  
Local Trade References#2
Company Name: Address:
Contact Person:
Telephone Number: ext Fax Number:
E-mail Address:  
Local Trade References #3
Company Name: Address:
Contact Person:
Telephone Number: ext Fax Number:

E-mail Address:
Method Of Payment For Services Rendered
Credit Debit Cards used for payments
Credit Card Used Amex MC/Visa Discover Account Number:
Mailing Address Used for Credit Card: Name on Account Authorized to sign for transactions:
Zip Code: Expiration Date: CVV2 Number on back of Card:
(What is this?)
In the event, Company has not been approved for credit trade services, and/or if, Company elects to pay for the cost of towing at the time of services rendered, I , an Authorized Agent, hereby authorize, The Semi-Towing Services Company, LLC, its Agent and/or authorized personnel to debit from the account designated above. The amount charged will be mutually agreed upon by , on behalf of Company and The Semi-Towing Services Company, LLC for all services rendered. There will be one charge assessed per vehicle(s) and trip for services rendered. The agreed amount will be deducted from the account checked in the box designated above.