Vehicle Release

Vehicle Release Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Drivers License FRONT*
Drivers License BACK*
Vehicle Description*
VIN*
Vehicle Identification Number
To*
Insurance Company or Third Party
I acknowledge that I have retrieved all my personal belongings and that the insurance company will be retrieving the vehicle. I release A Action Towing and Recovery Inc. of any liabilities.

I understand that if my insurance company for any reason does not pay the FULL tow and storage invoice that I will be responsible for paying the balance thereof. Payment will be required within 24 hours of pickup or a lien will be placed on the vehicle at the owners expense.
Signature

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Date/Time
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Vehicle Release Form