Affiliate Form

Bus Company Name

Does Your Firm Have a DBA

Yes

No

If so, Please List The Other Name

Primary Contact

Additional Contacts

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country Select Country Afghanistan Albania Algeria American Samoa Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Finland France French Polynesia Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Saint Martin Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Sudan, South Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe

Fax Number

Toll-Free No.

Website

Insurance Company

Contact Number

Liability amount _______(must be 1.5 to 5million minimum)

Policy Number

Insurance Expiration Date

Insurance Certificate On File

DOT#

Icc-mcc-number

Major City Served

Other Cities Served

Do You Accept Credit Cards

Yes

No

Have We Worked With You Before?

Yes

No

Year Business Started

Any Accident or Claim Within the Last 36 Months

State Tax ID

Federal TAX ID

24 hours dispatch available

Yes

No

How many vehicles in your fleet ?

Please list below your fleet information and quantity

Limousines

How many passengers

Year

Model

Party Buses

How many passengers

Year

Model

SUV's

How many passengers

Year

Model

Vans

How many passengers

Year

Model

Mini Buses

How many passengers

Year

Model

Motor Coaches

How many passengers

Year

Model

Sprinters

How many passengers

Year

Model

 

Vans. Same as above
Mini buses same as above
Motor coaches Same as above
Sprinters Same as above
Any additional fleet information you would like to add or describe

Please E-mail To rvptours@gmail.com or Fax us 954 404 6648