Fill this form out to appoint an Attorney-In-Fact for your vehicle. You must upload a copy of your ID to verify your identity. Fraudulent submission of this form is a punishable offense and will be prosecuted.

Upon signing this document I am freely admitting that I have the legal right to authorize Tri-City Towing Inc. to recover and tow my vehicle. I also agree and understand that circumstances outside Tri-City Towing Inc.'s control, with regard to the accident involving my vehicle, may make recovery and removal of my vehicle unusually difficult. And I unconditionally release, waive and discharge my right, whether by contract or under operation of law to file cause of action(s) or claim(s) which I may have against Tri-City Towing Inc. now or in the future. I hereby assume any and all risk of loss, liability, damage or costs, and understand that any and all damages that may occur will be as a result of the accident not as a result of any negligence on the part of Tri-City Towing Inc. I fully understand the terms set forth in this form, and I hereby waive my rights freely and voluntarily without any inducement, assurance, or guarantee being made to me to the fullest extent allowed by law.

Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties and will be prosecuted. Please allow 10-14 days to process your claim.