ParkerPilot Pilot Cars

1936 Crestview Drive
Bartlesville, Ok   74003
Toll Free: (877) 290-5164
Fax: (918) 337-2102



Pilot Car Operators Guild Membership Application

Fill out completely, attach documents and fax to program administrator at (918) 337-2102


Company Name: ________________________________________________________________


Contact Name: __________________________________________________________________


Street Address: _________________________________________________________________


City, Sate & Zip: _________________________________________________________________


Phone Number: _____________________________ Fax Number: _________________________


Email Address: ______________________________ Website: ___________________________


Number of Vehicles in Service: __________   Height Pole: __________


Passport: ___________   Tillerman Service:____________   Route Surveys:__________


Accept Terms & Conditions: _____________    Terms & Conditions


State Certifications: _______________________________________________________________


I, _____________________________________ certify that the enclosed information is true


Date: _____________________   Signature:___________________________________________



Please attach a copy of any State certifications, drivers license and insurance certifications.


We would like to thank you for your interest in the Pilot Car Operators Guild