Phone #
Applicant Details
{[CITY]}, {[STATE]} {[ZIP]}
City, State, ZIP
Business Name
Application Type
  • Contacts
  • Employees
  • Partners
  • Tow Vehicles
  • History
  • Insurance
  • Attachments & Certification
Please Indicate the Dimensions and number of vehicles capable of being stored for:
Please Indicate how long you have been engaged in the business of towing and storing vehicles
City, State, ZIP
Exterior Storage Area
Additional Information
Storage Location Details
Business Same as Applicant
Phone #
Business Office Ownership
Is the Storage Location the same as the office?
Business Name
Phone #
Please Indicate many of consecutive years you have been engaged in the business of towing and storing vehicles within the borough of Lodi
Phone #
Business Office Details
Storage Location Ownership
Interior Storage area
City, State, ZIP
Registered Agent Details
Listing of Applicant's Employees
Total Number of Employees
Total Number of Trucks
Tow Vehicles
History Information
Please indicate every locality for which you hold, or have held in the last five years, a police towing license .
You must also disclose any complaints registered by the public or others concerning your performance within such other jurisdiction.
Worker Compensation Name
Comprehensive Insurer Address
Vehicles Insurer Name
Excess Umbrella Address
Garage Keeper Name
Excess Umbrella Policy Number
Insurance Information
Worker Compensation Policy Number
Garage Keeper Policy Number
Garage Keeper Address
Vehicles Insurer Address
Comprehensive Insurer Policy Number
Worker Compensation Address
Vehicles Insurer Policy Number
Excess Umbrella Name
Comprehensive Insurer Name
Type Full Name :
Sign With Hand
Page Title

The Undersigned does hereby appoint the Borough Clerk of the Borough of Lodi as the Applicant's true and lawful attorney to accept service of process issuing out of any Court of competent jurisdiction.

The undersigned agrees to be available and provide for the services required pursuant to this Ordinance and to abide with all of the fee or other requirements herein during the term of applicant's license, including any renewal of same and during the period it provides services to the Borough, pursuant to this Ordinance and any other applicable ordinancne of the Borough of Lodi.

The undersigned consents to permit the Borough of Lodi to investigate and obtain, for purposes of this Ordinance only, a criminal background check and driving abstract.

undersigned agrees that the relationship between the licensed tower and the Borough is one of an independent contractor. Neither party shall be construed in any manner whatsoever to be an employee of the other, nor shall any employee or agent of any party be construed to be an employee or agent of the other party. Inclusion in the licensed towers list shall not be construed or considered as a joint venture, partnership, association, contract of employment or profit-sharing agreement between the parties.

The Undersigned hereby certifies that all information in the within application is true and accurate as of the date below
Type Fee
Towing Establishment $262.50
Per tow truck $52.50
Annual License $1000
Annual Operator fee: $100

Please Provide the following if applicable or not provided earlier in the form:

  1. A list of every locality for which the tower holds, or has held in the last five (5) years, a police towing license.
    This list shall also disclose any complaints registered by the public or others concerning the applicant's performance within such other jurisdiction.
    1. Copy of the deed to the storage area and, if separate from the storage area, office premises.
    2. If either or both are leased, a copy of the lease and certification of good standing of the lease signed by the property owner.

  2. Current survey, not older than one (1) year and photos of the storage and office premises of the applicant.

  3. Descriptive list (make, model, year) of all vehicles owned by the applicant which are to be used for the services, setting forth the vehicle identification number and license registration number of each vehicle:
    1. If the vehicle is leased, a copy of the written lease instrument confirming it is available for use during the license period.
    2. Declaration pages of all insurance policies.
    3. A list of all persons who shall be designated as drivers for the applicant, with their driver license numbers .
Amount Due
Fee Schedule
Applicant Signature