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Towing Complaint Form

2. Date of Tow*

3. Address/Location of Tow*

7. First Name*

8. Last Name*

9. DOB*

   MM/DD/YEAR

11. Driver License #

12. State:

13. Phone #*

    999-999-9999

15. Address1*

17. City*

18. State*

19. Zip*

21. Email address

25. Vehicle Make*

26. Model*

27. Color*

28. Tag #*

30. State*

32. Name of Towing Co.

33. Phone #

37. Nature of Complaint*
    -- Select One --OverchargedRefused to Release VehicleDamage/TheftPayment Options24-Hour AvailabilityDelayed ServiceRudenessOther (indicate specifics in narrative)

38. Receipt or Tow Bill

40. Additional Information*

    Please type a brief statement with the pertinent facts of your complaint.

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

* indicates a required field