Roadside Assistance Platform
Working in Communities,
for Communities
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Industry Partners
About
Service Solutions
Provider Network
Rewards
Home Assist
BUY ROADSIDE ASSISTANCE
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Network Provider Input Details
*
Indicates required field
GENERAL INFORMATION
Business Name
*
ABN
*
Address
*
Postcode
*
Suburb
*
State
*
BANKING INFORMATION
Bank Account Name
*
Bank BSB
*
Bank Account Number
*
TERMS AND CONDITIONS
*
I accept the terms and conditions
CONTACT INFORMATION
Main Contact
*
First
Last
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Main Phone
*
Mobile
*
Emergency Phone
*
Email address
*
Website
*
Other Contact
*
First
Last
Other Phone
*
SERVICE LOCATIONS
Locations List
*
Single Location
Multiple Location
List of Locations
*
Please enter location of each site
SERVICE INFORMATION
Type of Service
*
Tow
Battery
Locksmith
General Roadside
General Roadside and Tow
Region Serviced
*
Please enter the regions serviced
Type of Vehicle
*
Please enter the types of vehicles in your service fleet
Please enter the minimum and maximum towing weights, as well as whether you can service lowered vehicles?
Towing Details
*
Please enter all you Insurance details (Insurance Coverages eg: Professional Indemnity, Hook Liability and Public Liability)
Comment
*
Please upload your scanned documents below
Insurance document 1
*
Max file size: 20MB
Insurance document 2
*
Max file size: 20MB
Other files
*
Max file size: 20MB
Please enter the fees you charge for each service.
Fee for 20kms
*
Fee for 100kms
*
Fee for 50kms
*
Fee for 250kms
*
Submit