Release Form | Lebanon, OH

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Innvoice*

Tow Date*

Year, Make, Model*

Owner First Name*

Owner Last Name*

Address:*

City: *

State/ Province

ZIP/ Postal Code*

Phone: *

Release Date*

Release To*

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I am the legal and rightful owner of the above listed vehicle presently stored on the property owned and operated by Jacob's Towing, Inc. and thus authorize the personnel of said vehicle to the following person(s) and or insurance company, and/or agent therof

Furthermore, I understand that in the event that the aforementioned motor vehicle is to be release to an individual person, that person will be required to present a valid photo identification card that must be in one of the following forms:

1) Any U.S. State issued drivers license 2) Any U.S. state issued personal identification card 3) U.S. Military identification card 4) U.S. Government issued Passport

Notice

A Copy of your drivers license and motor vehicle registration card, certificate, or title MUST accompany this form.

Owner Signature At Time of Release:*

I consent to signing this using an electronic typed signature, and agree that my electronic signature is the legal equivalent to my handwritten signature

I agree

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*All fields marked with an asterisk * are required