YPSO Towing Service Application Form

York-Poquoson Sheriff's Office

Towing Service Application Form
Name of Business:
Business Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Storage Lot Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tow Company Dispatch Telephone Number:
Authorized person(s) of towing service to speak on behalf of the business:
Name:
Phone Number:
Name:
Phone Number:
Do you have a current business license?

YesNo
Do you have Liability Insurance?

YesNo
Where is the towing firm located?

York CountyPoquosonWilliamsburgJames City County
Other location (Heavy duty list only)
Equipped to handle (check all that apply)

CarsVansPick-up TrucksBusesTwo-Axle TrucksMotorcyclesTractor TrailersThree-Axle Trucks
Where is the storage facility located?

York CountyPoquosonWilliamsburgJames City County
Other location (Heavy duty list only)
Can vehicles be stored in a fenced area or locked inside a garage in York County?

YesNo
Check all lists where you intend to provide service:

Light Duty List - Lower YorkLight Duty List - Upper YorkHeavy Duty List - Lower YorkHeavy Duty List - Upper York
Please attach copies of the following:
Liability Insurance Policy:

Cancelof
Current Business License:

Cancelof
DCJS DAD cards (each driver):

Cancelof
By initialing below, you are acknowledging you have reviewed and received a copy of each:
- York Poquoson Sheriff’s Office Policy GO 2-33 Towing of Vehicles
- County Ordinance - Article V - Towing
Initials:

Clear

Please List Drivers Names. OPERATOR LICENSE NUMBERS WILL BE REQUESTED FROM YPSO AND MUST BE PROVIDED DIRECTLY TO THEM FOR EACH OF THESE LISTED BELOW:

	Driver Name	OL Number	OL Expiration
1
2
3
4
5
6

Provide the Year, Make, Model for towing vehicles to be considered for approval. Each tow vehicle must meet all local and state requirements for commercial towing operations, including current registration, insurance, required equipment and inspection. All tow vehicles will be inspected by the tow liaison.

	Vehicle Year	Make	Model	License Plate #
1
2
3
4
5
6

NOTE: All listed firms shall notify the Sheriff’s Office in writing of any changes to this application or services provided, within 30 days of any changes.
Initials:

Clear
By signing below, you are acknowledging on behalf of the business and all related parties to the business to following the York-Poquoson Sheriff’s Office policy, York County Ordinance, and all State laws that are applicable.

Name and signature of owner or authorized representative of towing service:
Name:
Signature:

Clear
Title:
Should be Empty: