Absolutely Nautical / Truckaboat USA
Contact Budd Aubry
Sandbar Enterprises
4917 N.E.18th Terr.
Ft. Lauderdale, Fl. 33308
954-202-9284 Fax: 954-771-2337
email:
budd@truckaboat.com
http://www.absolutelynautical.com / http://www.truckaboat.com

(Print This Form and Fax or Copy and Paste to email)

Truckaboat USA / Escort Pilot Car Service
Please complete this form Fax with credit card orders
or Mail if joining by check or money order

Company Name: _________________________________________

Your Name: _______________________________

Address: _______________________ City: ________________ State: ___ Zip: __________

Business Address: ________________ City: _______________ State: ___ Zip: __________

Phone: (Home) _____________________ (Business) _____________________

Fax: _________________ E-mail: ___________________ Other: __________________

Insurance Information: _______________________________________________

License Class: ____ Certification # : _______________ Authority: ____________________

Vehicle: Year: ____ Make: ____________ Model: ______

Desired Areas of Operation: All 48 states: __ North __ South __ East __ West __

Eastern seaboard: __ Southeast: __ Mid-Atlantic: __ New England __

Midwest __ South Central __ North Central __ Southwest __ Northwest __

Central Mountain __ West Coast __

Include any additional information you want displayed on your page.

If you want to add a photo please send photo with self addressed stamped envelope

$ 125 for 6 months __ $250 for 1 year __ Amount: _________ Date: ______

Credit Card Information

Card Name: Master card: ___ Visa: __

Account number: _______________________________ Expiration Date: _________

Card Holder: (Please print) ___________________________

Signature: _____________________________

*Please Note: Your credit card order will be processed by AIM Marketing
*their name will appear on your credit card statement for the amount of this purchase.
*($15 fee will be charged for re-processing of charge backs)

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