Please complete and submit the Vehicle Owner Release Form below to authorize the release of your vehicle.

"*" indicates required fields

Please ask our office for your Reference Number if you do not have it.

Registered Owner Information

I, the undersigned, am the legal and rightful owner of the below listed motor vehicle presently stored on the property owned and operated by ROADSIDE RESCUE & TRANSPORT INC., 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:
Address*

Motor Vehicle Information

Authorized Person/Company

Authorized person or insurance (Person or company you are allowing to take the vehicle). For Insurance companies fill out company name and claim number, For Individuals all info must be filled in.
Address

Acknowledgement

Roadside Rescue & Transport, Inc. appreciates your business. If you have any questions about your invoice, please call us at 781-444-1211. All involuntary towing charges are invoiced pursuant to 220 CMR 272.00. All other charges are invoiced in accordance with a private agreement made with the vehicle owner, an insurance company, or an authorized agent and are not subject to regulation. By signing below, releasing my vehicle from impound, or removing my vehicle from the impound lot, or accepting delivery of my vehicle I agree to pay all charges on the invoice in full. I further agree to release and hold harmless Roadside Rescue & Transport, Inc. of any and all liability arising out of the services rendered, including all claims or causes, past, present, or future arising from the delivery or mis-delivery of the motor vehicle and its contents.


NOTICE VEHICLE OWNER:
A copy of your drivers license and motor vehicle registration card, certificate, or Title MUST accompany this form. In the event that the owner is authorizing this release from either a hospital bed, or while being detained in any prison and/or jail, he/she must have this form signed and witnessed by a legally certified/commissioned Notary Public (see below).
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.