Road Rescue Network - Fleet Customer Registration

1
What's your company name?* This field is required.
2
What type of business are you?* This field is required.
Trucking Company / Carrier
Fleet (Non-Trucking)
Auto/Truck Dealership
Logistics / Freight Broker
Bus / Passenger Transportation
Construction / Heavy Equipment
Government / Municipal
Other
3
How many vehicles are in your fleet?* This field is required.
1-10 vehicles
11-50 vehicles
51-100 vehicles
101-500 vehicles
500+ vehicles
501+
4
Who should we contact for service requests?* This field is required.
First Name
Last Name
5
What's your title or position?
6
What's the best email for dispatch notifications?* This field is required.
7
What's your 24/7 dispatch phone number?* This field is required.
8
Is this number staffed 24/7?
Yes - 24/7
Business hours only
After hours goes to voicemail
9
Is billing handled by someone else?
No - same as above
Yes - different billing contact
10
Billing Contact Name
First Name
Last Name
11
Billing Email
12
Billing Phone
Area Code
Phone Number
13
What's your company headquarters address?* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
14
Where do your vehicles primarily operate?* This field is required.
Nationwide
Northeast
Southeast
Midwest
Southwest
West Coast
Pacific Northwest
15
What services does your fleet typically need?* This field is required.
Mobile Truck Repair
Mobile Trailer Repair
Commercial Tire Service
Towing - Light Duty
Towing - Medium Duty
Towing - Heavy Duty
Jumpstarts
Fuel Delivery
Lockout Service
Reefer Repair
RV/Bus Repair
Preventative Maintenance
Accident Recovery
Load Shifts
16
How many service calls per month?
Less than 5
5-20
21-50
51-100
100+
500+
1000+
17
How do you currently handle roadside emergencies?
We call around ourselves
In-house maintenance dept
Dispatcher looks for us
No solution yet
18
How would you like to pay?* This field is required.
Credit Card on File
EFS, Comdata, T-Chek
Fleet/Fuel Card
Road Rescue Network Portal Access (Fund Prepaid Account)
19
Federal Tax ID / EIN (for invoicing)
20
Any special requirements or notes?
21
How did you find Road Rescue Network?
Google Search
Referral
Social Media
Trade Show
Sales Rep
Broker / Freight Forwarder
Other
22
Choose a Username for your fleet portal* This field is required.
23
Choose a Password (min 8 characters)* This field is required.
24
Review and accept our terms* This field is required.
I agree to Terms of Service
I am authorized to create this account
25
Electronic Signature* This field is required.
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