Forms

Vehicle Release Authorization

Name (First and Last, required)

Email (required)

Phone number(required)

I verify that I am the registered owner of a

Make

Model

Year

Color

VIN

Company Name (if applicable)

Select One
I authorize the release of my vehicle to an insurance company for pickupI authorize the release of my vehicle to the following:
If releasing the vehicle to an individual, please complete the following. The individual picking up the vehicle must show a government issued photo I.D. at the time of pick up.

Full Name as it appears on the driver's license:

License number:

Driver’s license state issued:

Expiration:

Copy of Vehicle Release (if applicable)

Upload a copy of registered owner’s license

Upload a copy of individual authorized to pick up the vehicle