Vehicle Release Authorization Form

1

Vehicle Owner Information

Owner's Full Name *

Owner's ID Number *

2

Towing Company Name *

Date *

Towing Company Address *

3

Make *

Model *

Year *

Color *

License Plate / Tag # *

Tag / Registration State *

Tag / Registration County

Tag Type

Tag Issued Date

Tag Expiration Date

VIN Number *

4

The person you are authorizing to pick up your vehicle on your behalf.

Authorized Person's Full Name *

Authorized Person's ID Number *