Tow Service Request

Wrecker, winch-out, recovery and sub-swap dispatch for down tractors and trailers.

1 · Service Needed

Requester's Company Name

Your Name

Callback Number

Type of Tow Service

Driver's Name

Driver's Phone Number

Is the trailer loaded?

Truck or Trailer Unit Number

Year / Make / Model

Break Down Location (If on a road that has exits include Mile Marker, Exit Number or Grid Coordinates)

Concern/Failure Description

Select a payment type and enter the customer account number next to it.

AmbestAccount In HouseOnline/Other

Contracted rates auto-applied for Ambest: $130.00 service charge · $165.00/hr labor · fuel surcharge ON.

Reference #

P.O. #