HPD Operator/Driver Info Form

Fill this form out for each Tow Truck Driver/Operator.

Business Name*

Application Date*

Last Name*

First Name*

Middle Name/Initial

Title or Position*

Select or enter value

Date of Birth*

Driver's License #*

Driver's License Expiration Date*

BCI Criminal History Report Issue Date*

UDOT Tow Truck Operator Certificate Issue Date*

Drivers License Division Report Issue Date*

Wrecker Certification Type*

Select or enter value

Wrecker Certification Expiration*

Medical Card Expiration Date*

Cell Phone #

Physical Address

City

Zip Code

Required Attachments*

Copy/Picture of Driver's License (Front and Back)

Copy/Picture of Medical Card (Front and Back)

Tow Truck Driver Certification Card (Front and Back)

Copy/Picture of UDOT Tow Truck Operator Certificate

Copy/Picture of DLD Report

Copy/Picture of BCI Criminal History (UDOT Cert Accepted)

Copy/Picture of Tow Operator Agreement

Drag and drop files here or

Send me a copy of my responses