The undersigned wrecker service hereby applies to the state highway patrol to be placed on the approved lists of such services:
1. Name and address of firm:
2. Names and addresses of all persons having a financial interest in such firm:
(If additional space is needed, please continue on the reverse side hereof.)
3. Names and addresses of drivers and attendants:
a. Name:
Address
Number of years employed by firm: Training: Total years of experience in towing:
b. Name:
Address:
Number of years employed by firm: Training:
Total years of experience in towing:
(If others, please give the same information on the reverse side hereof.)
(Name of firm)
By:
(Authorized signature)
Approved this day of , 19 .
(Title)