Vehicle Owner Authorized Agent Form / Insurance Assignment Form

23933 SE 264th Street, Maple Valley, WA 98038

420 H St NW, Auburn, WA 98001

Phone: 253-245-5454 / Fax: 253-245-5228

https://www.pro-tow.com/contact-us/get-your-car/

Date: *

Time: *

Vehicle License Plate Number: *

Good Faith Estimate:

Year, Make, & Model: *

Who Are You authorizing To Act On Your Behalf? *

Insurance Company: *

Insurance Policy Nymber: *

Government Issued Photo ID. Either Valid or Not Expired For More Than 90 Days: *

Maximum file size: 268.44MB

Insurance Identification Card. Photo or Scan:

Maximum file size: 268.44MB

Consent, Agreement, and Authorization: *

I authorize the tow and/or impound. I understand and authorize all supplies and storage charged, and that hourly rates charged have been computed from the actual time the truck(s) departed in response to the call until the truck(s) returned to its place of business and completed all necessary unloading, cargo handling, debris handling, environmental cleanup, equipment and tool cleanup, property damage repair, and paperwork as deemed required by the tow truck operator at the time of service. I have received a Good Faith Estimate and I approve of all charges. I approve the 5% processing fee. I further consent to the transport of my vehicle(s) to PRO-TOW’s secured storage facility where it will be held until the bill for all services rendered, including storage, has been paid-in-full. I understand that the attorney’s fees will be incurred to enforce these provisions. I hereby certify that I am legally authorized to appoint the following person to act as my agent to sign all papers and documents that may be necessary in order to view the vehicle, obtain any and all personal belongings from my vehicle, and/or redeem the above vehicle from towing impound. I agree to guarantee and save the State Of Washington, the Director of Licensing, PRO-TOW and any of its employees or agents, from all responsibility for any legal action which might arise from allowing this said person to view the vehicle, retrieve personal belongings, and/or redeem the vehicle on my behalf. I hereby authorize and instruct my insurance company to pay the full amount of my outstanding indebtedness owed to PRO-TOW, its subsidiaries, or other dba entities directly.  In the event my bill is not paid in full, PRO-TOW may at its sole discretion, treat this assignment as continuing in full force and effect and proceed to collect my bill through any and all appropriate means.

Name of Current Owner or Authorized Agent: *

Email Address of Current Owner or Authorized Agent: *

Phone Number of Current Owner or Authorized Agent:

*

Yes I Have Read And Agree To The Consent, Agreement, and Authorization Included In This Form.

Signature of Current Owner or Current Authorized Agent: *

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Vehicle Owner Authorized Agent Form / Insurance Assignment Form

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