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NEW Service Providers

This premium network is not a directory or referral service! We are limiting memberships to a maximum of 1 (one) Quality Service Provider per city of operation. We require all members to actively participate in the alliance and comply with our strictly enforced Safety and Quality Standards. If you would like to know more of how to become an affiliate member, please complete all the information requested below.

Thank You!

Information Request Form

Company Name

DBA (if other than above)

Primary Contact



 Pres./Chm.Gen. Mgr.VPOwnerPartner





Zip/Postal Code


Toll Free




URL/Web Address (if available)

In business since


NLA Member

Yes    No

Other Association Membership(s)  

Government Authorized City(ies) of Operation

What are your company's hours of operation? 

Are you able to receive and confirm reservations 24 hours a day/365 days a year

Yes    No

Do you have a formal dress code for your drivers, including dark suit and tie? Yes    No
Do your drivers get periodically drug and alcohol tested? Yes    No
Do your drivers get criminal background checks? Yes    No
Do your drivers submit to periodical health checks? Yes    No
Please list the fleet directly owned by your company

(Please indicate Vehicle Type/ Manufacturer/ Model / Year/ Number of vehicles)

What is your present automobile insurance liability coverage limit?

(For outside USA, please indicate currency!)

Combined Single Limit
Bodily Injury per person
Bodily injury per accident
Property Damage per accident 
Name of Insurance Company
Additional Comments

Please push the SUBMIT button only once. It can take a moment until the Confirmation Page shows.


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Revised: February 27, 2011


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