Vehicle Release Form
I, _____________________________________________, am the legal owner of the below listed motor vehicle
presently stored by Southside Towing, and thus authorize the personnel of said company to release said vehicle to the
following person(s) and/or insurance company, and/or agent thereof:
NAME: (authorized person or Insurance Company)
ADDRESS: _______________________________________ CITY: ____________________ STATE: _____
ZIP CODE: ____________ PHONE: (_______) _________________
CLAIM #: (if applicable) _________________________________________________________________
MOTOR VEHICLE INFORMATION:
YEAR: ____________
MAKE: _______________ MODEL: ______________________
COLOR: ____________ VIN #: _________________________________________________
OWNER INFORMATION:
NAME: __________________________________________
DRIV LIC #: __________________
ADDRESS: _______________________________________ CITY: ____________________ STATE: _____
ZIP CODE: ____________ PHONE: (_______) _________________
Attach Copy of Drivers License Here
A copy of your drivers license MUST accompany this form.
Southside Towing | 1643 Placentia Ave. Costa Mesa, CA 92627 | 551 N. Batavia St. Orange, CA 92867
www.southside-towing.com