AFFILIATE REGISTRATION FORM
ALL FIELDS MARKED WITH AN ASTERISK (*) ARE REQUIRED.
Transportation Company Information
Contact Information
Contact Mobile Phone Number:
Operations Information
24Hrs. Dispatch Number (if available):
What dispatching software you use?*:
Appropriate level of insurance coverage*:
All certificates from operating authorities*:
Fleet Information
Vehicle Types
Please check all that apply*:
E-Signature of Approver
Please note that approver must be an officer or authorized agent legally able to bind the Company.
By typing your name in the above box and submitting this application electronically you are certifying that the above listed information is correct and you have read and agreed with the Affiliate Terms & Conditions published on Diplomat Limousine Service website. Also authorizing Diplomat Limousine Service to verify the above information anytime if needed.
Title of Approver