Application

Business Information

Physical Business Address

Billing Address Different than Business Address

ext

ext

ext

ext

Yes No

Methods for receiving dispatch information

Payment types accepted

Services


LightDuty

Fluid Delivery
Jump Start
Jump Start - 6 Volt Battery
Tire Change
Tire Repair
Tow
Tow - Enclosed Hauler
Tow - Flat Bed
Tow - Low Clearance
Tow - Motorcycle
Tow - Repo
Winch

MediumDuty

Fluid Delivery
Jump Start
Tire Change
Tire Repair
Tow
Tow - 5th Wheel
Winch

HeavyDuty

Fluid Delivery
Jump Start
Tire Change
Tire Repair
Tow
Tow - Landoll/Lowboy
Winch

Other

Home Locksmith
Basic Lockout
Locksmith
Mobile Mechanic
Mobile Mechanic - Diesel
Mobile Mechanic - RV House
Mobile Mechanic - Welder

Additional

Tow - Air Suspension/Brake Hookup
Tow - Dollies
Tow - Drop Drive Line
Tow - Ramps
Tow - Soft Straps

Zip Codes

Yes No

Yes No

Please provide us a list of zip codes you cover. Please identify which zip codes you can cover within 45 minutes and those that take over 45 minutes to respond.

Primary: zip codes covered in less than 45 mins

Please enter zip codes separated by a comma. Example: 76006, 76007, 76008

Secondary: zip codes covered in over 45 mins

Please enter zip codes separated by a comma. Example: 76006, 76007, 76008

Towing Software

Yes No Don't know

Electronic W-9

Request for Taxpayer Identification Number and Certification (W-9)
As you know, Pinnacle Partners Solutions, Inc. will need your W-9 information for federal tax reporting. Information sent from this website is encrypted and you can securely provide your W-9 electronically using the form below. However, if you are an individual (not a business) and prefer not to submit your SSN electronically, you can manually complete a W-9 Form and fax it to 800-331-1145. Click here for a W-9 Form

Tax Classification *

W-9 Address Different than Billing Address

Part - I Taxpayer Identification Number (TIN)

If this is corporation, LLC or other business entity, please provide your federal Employer Identification Number (EIN). If this is an individual and not a business, please provide your Social Security Number (SSN).

Part - II Certification

Under penalties of perjury, I certify that:
  1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
  2. I am not subject to backup withholding because : (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
  3. I am a U.S. person (including a US resident alien).

Insurance

Pinnacle Partners Solutions, Inc. requires the following insurance coverage:
  • Commercial General Liability : $300,000 / occurrence min
  • Commercial Auto Liability : $300,000 / occurrence min (Required for Roadside Assistance w/Towing)
  • Garage Keepers / On Hook / Cargo : $100,000 / occurrence min (Required for Roadside Assistance w/Towing)
  • Workers Compensation for employees
  • Statutory Limits

ext

Certificate of Insurance

We must have a copy of your current certificate of insurance to maintain on file.

Pinnacle Partners Solutions, Inc. must be listed as an Additional Insured on the certificate.

Include your Service Provider/Vendor ID # on the insurance certificate.

If you have an electronic copy of your insurance certificate, please upload the file below:

If you do not have an electronic copy, please fax or mail a copy.

Fax : 800-331-1145

Mail : Service Provider Department. 800 Point Vista Dr Ste #532 Hickory Creek, TX 75065-7639

Terms and Conditions of Service Provider Agreement

*Click here to view the terms and conditions

IN WITNESS WHERE OF, this Agreement has been executed by the duly authorized representatives of the parties hereto as of the date accepted and executed by Pinnacle Partners Solutions, Inc. as set forth below.