auto body release form

Name

Phone Number

Vehicle Year

Vehicle Model

Vehicle Make

Plate Number

Choose an auto body shop:

If the body shop of your choice is not listed above please list it below:

If you do not wish to choose a body shop, check the box below:

"I do not wish to choose a body shop at this time"

Electronic Signature:

Legal:

This information above is true and correct to the best of my knowledge. This electronic signature is valid and is the exact name on my State Issued ID or Drivers License. I agree and I am aware that the IP address on submission of this form will be documented by CJ'sTowing & Recovery and may be used in a court of law in leiu of a handwritten signature.