[an error occurred while processing this directive] Application


Please select program and method of payment and then complete the information form below.

Standard Listing: $50.00 per Year
Your facility will be listed in our database alphabetically by State, City and Shop Name.


AITA Authorized Service Provider
Enroll Today!!!

Please provide the following information:

Company Business Information Mailing Address; if different
Name: Name:
Address: Address:
City: City:
State: State:
Zip Code: Zip Code:
Contact Info:
Phone: Fax:
Night Phone: E-mail
Company Web Address: Fed ID #:
Your Name: Title:
Service Radius: AITA Promotion Code


Motto, Slogan or preferred statement about your service




Please indicate the services you provide:
(check all that apply)
24 Hour Service Air Conditioning Alignments Brake Systems
Computer Diagnostics Diesel Mechanic DOT Inspections Fuel Delivery
General Repairs Jump Starts Nationwide Towing Recovery
Reefer Repairs Road Service Scales Tire Repair
Tire Sales Truck Stop Towing Trailer Repair
Trailer Change Truck Wash Welding Winching


Other Conveniences
Drivers Lounge Private Showers TV Access Internet Access
Lodging Nearby Shopping Nearby Restaurants Nearby


Methods of Payment
American Express Discover Card MasterCard Visa
ComChek EFS Fleet 1 PayPal
T-Chek TCH Wright Express


Thank you. A representative will contact you soon.





�2004 

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