Base Affiliation Application

Name*

First NameLast Name

Primary Phone*

Please enter a valid phone number.

Second Phone

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Vehicle owner driver's license number*

Copy of the vehicle owner driver's license*

A copy of the company's filing receipt if the vehicle is owned by a corporation

Vehicle Identification number (VIN)*

Proof of vehicle (Title, registration, or bill of sale)*

SPACELINKS ANNUAL BASE AFFILIATION FEES*

Base AffiliationAnnual Base Affiliation Fees

$200.00

Total

$0.00

Verify Your Account
Stripe verifies your account by depositing two small amounts into your bank account.Enter these two deposits into the text boxes below, and click on the Verify button
First Deposit:
Second Deposit:

Bank Account
Email
Routing Number	Account Number
Name On Account	Bank Account Type

DISCLAIMERS*

** This is NOT a Promise to Hire**&#13;&#10;&#13;&#10;The purpose of this form is satisfy the TLC requirement mandating all FHV to be affiliated with a TLC licensed Base.  Submitting this form does not constitute a promise or a commitment to hire you or partner with you by SPACELINKS. &#13;&#10;&#13;&#10;** SMS Sign-up and Opt-In.**&#13;&#10;&#13;&#10;By submitting this form, you consents to receive text messages from the company for advertising purposes related to its services, promotions, or relevant updates. Message frequency varies. Unsubscribe any time by replying STOP.&#13;&#10;&#13;&#10;** Privacy Policy.**&#13;&#10;&#13;&#10;Please consult https://www.spacelinks.us/privacy-policy for more information on the use of your personal information.&#13;&#10;

I agree to submit the following vehicle documents and update Spacelinks in case of vehicle replacement or change of ownership*

- DMV Registration Card &#13;&#10;- TLC License (Diamond Sticker) &#13;&#10;-FHV Insurance (FH1 Dard, Certificate of Insurance, and Declaration Page)&#13;&#10;- Proof of ownership (e.g, Title, Bill of Sale) &#13;&#10;&#13;&#10;These documents must be submitted through this link: &#13;&#10;

Signature*

New Vehicle Base Affiliation

DOCUMENTS