NON-CONSENT TOW TRUCK PERMIT APPLICATION

NON-CONSENT TOW TRUCK PERMIT APPLICATION

(This Application Form to also be used for Permit Renewals)
Application MUST include the following documents:
1. Vehicle Registration Listing (“cab card”)
2. Current Registration
3. Most recent Tow Truck Invoice
4. Schedule of Tow Company’s Non–Consent Fees posted on TxDot website
5. Original business card
6. Vehicle Inspection
7. Authorization letter for use of each Vehicle Storage Facility listed on application
8. Evidence of insurance coverage or financial responsibility for each tow truck
9. Original CERTIFICATE OF INSURANCE naming "Brazoria County, Texas" as certificate holder
10. Payment of Fees
- Permit Number*
- SolePartnerCorp
- NewRenewalReplacementSubstitute
- Name of Partner(s) or Corporation Officer(s) (If Applicable)
- Partner or Corporation Officer Address (If Applicable)
- Partner or Corporation Officer Phone Number (If Applicable)
  Please enter a valid phone number.Format: (000) 000-0000.
- Physical Address*
  
  Physical Address
  
  Street Address Line 2
  
  CityState / Province
  
  Zip
- Mailing Address*
  
  Mailing Address
  
  Street Address Line 2
  
  CityState / Province
  
  Zip
- Primary Phone Number*
  Format: (000) 000-0000.
- Secondary Phone Number (If Applicable)
- Contact Person*
- Contact Person Email*
  example@example.com
- Contact Person Mobile Phone*
  Format: (000) 000-0000.
- Contact Person Fax Number
  Please enter a valid phone number.Format: (000) 000-0000.
- YesNo
- Lift Capacity (pounds)*
- License Plate*
- Year*
- Make*
- VIN*
- Current Permit if applicable
- Division*
- Storage Facility*
- Vehicle Storage Facility Number*
- Address*
  
  Address
  
  Street Address Line 2
  
  CityState / Province
  
  Zip
- Contact Person*
- Email*
  example@example.com
- Phone Number*
  Format: (000) 000-0000.
- Division
- Storage Facility
- Vehicle Storage Facility Number
- Address
  
  Address
  
  Street Address Line 2
  
  CityState / Province
  
  Zip
- Contact Person
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Division
- Vehicle Storage Facility
- Vehicle Storage Facility Number
- Address
  
  Address
  
  Street Address Line 2
  
  CityState / Province
  
  Zip
- Contact Person
- Contact Person Email
  example@example.com
- Contact Person Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Vehicle Registration Listing (Cab Card)*
  
  Cancelof
- Current Registration*
  
  Cancelof
- Most recent Tow Truck Invoice*
  
  Cancelof
- Schedule of Tow Company's Non - Consent Fees*
  
  Cancelof
- Scanned Business Card*
  
  Cancelof
- Vehicle Inspection*
  
  Cancelof
- Authorization Letter for Use of Each Vehicle Storage Facility Listed on Application*
  
  Cancelof
- Evidence of insurance coverage or financial responsibility for each tow truck*
  
  Cancelof
- Original CERTIFICATE OF INSURANCE naming "Brazoria County, Texas" as certificate holder*
  
  Cancelof
- APPLICANT AGREES TO INDEMNIFY AND HOLD HARMLESS BRAZORIA COUNTY IN THE EVENT OF DAMAGE TO OR LOSS OF ANY MOTOR VEHICLE, OR THE CONTENTS THEREOF, HANDLED BY THE TOWING COMPANY OR INJURY OR DAMAGE TO ANY PERSON OR OTHER PROPERTY AS A RESULT OF NON-CONSENT TOWING SERVICES PERFORMED BY APPLICANT OR THE TOWING COMPANY
- Applicants Printed Name*
- Application Date*
  
  MonthDayYear
  Date
- Applicants Signature*
  
  Clear
- FALSIFYING ANY GOVERNMENT DOCUMENT IS A CRIME AND WILL BE PROSECUTED
- Should be Empty: