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ELITE AUTO RECOVERY
752 Old Rte. 9 North
Wappingers Falls, NY 12524
Tel: (845) 202-0111

  Private Property Impound Request Form

 

PLEASE NOTE:

 
Removal Requested By :

Phone Number :

Address :

City, State, Zip :

Car Make :

Car Model :

Car Year : Color :

Licence Plate Number :

Car Vin Number :

Does Vehicle have tires?
Yes
No
By typing your name in the box below, you are certifying that you are the property owner, or have the authority to act on the owners behalf.

The above described vehicle has been left unattended or abandoned on my personal property.
ELITE AUTO RECOVERY has my permission to remove this vehicle as soon as possible.


E- Signature

SUMIT RESET


 

Please Complete this form, the requested information is necessary to remove the correct vehicle, and to determine the necessary equipment for proper removal. In addition to an e-signature, you must be present at the time of pick up to sign a waiver in person.

ONLY A PROPERTY OWNER, OR PERSON AUTHERISED TO ACT ON BEHALF OF THE PROPERTY OWNER SHOULD REQUEST A VEHICLE REMOVAL.

TAKE NOTICE THAT IN THE EVENT YOU DO NOT HAVE THE PROPER ATHORITY TO REQUEST AN IMPOUND, YOU MAY BE HELD LIABLE FOR DAMAGES INCURED BY THE VEHICLE OWNER.