Please call Danny at 850-545-9185 prior to sending form to dannyBtows@gmail.com

Copy & paste in your e-mail send to DANNYBTOWS@GMAILCOM

I,,______________________have provided proof of legal ownership of the vehicle listed below or a

notarized statement to represent the legal owner with a valid photo identification. I authorize the
wecker company to release the vehicle to:
__________________________________________________________________________
Company / Person Releasing Vehicle to Pick Up

VIN _______________________________ 

                                                                                  
Year_______ Make__________             



Model_______Color_______ Tag____________  
               
_______________________________                  ____________________________
Print Name                                                        Phone Number                                     _______________________________                  __________________________

               
______________________________
  Signature                                                      Date Signed                                                   ________________________________        DL#---------------------------------------                                                                 
                Type of ID  and  Valid ID #           

Picked up by _________________ on__________ Released by__________ID#_________