Request Form

Customer Information

Vehicle Infomation

License Plate Infomation (if Known)
Do not get out of your vehicle to look at your plate if you
are in a dangerous situation!

Providing your license plate information allows us to
quickly search for discounts and deals with NMVHTSB.
Two letter state, then provide your plate information.

*Are you with the vehicle needing service now?
Yes No

You must have location services enabled.

By clicking on the button, you approve location data sent to Emergency Assistance Service.