DATE _______________ 

I HEREBY AUTHORIZE THE ABOVE TOWING FIRM

TO REMOVE THE FOLLOWING VEHICLE:

YEAR _________ MAKE ___________________ MODEL ________________

COLOR _______________ VIN #____________________________________

TAG #______________________________ STATE _____________________

PROPERTY NAME _______________________________________________

LOCATION _____________________________________________________

______________________________________________________________

REASON _______________________________________________________

AUTHORIZED BY _________________________________________________

JOB TITLE ______________________________________________________

CALL BACK # ___________________________________________________

G & G TOWING

421 DOVER RD

ROCKVILLE, MARYLAND 20850

PHONE # (301) 762-6023

FAX # (301) 762-2788