Minimum: $______________________
Minimum: $______________________
$________________________________
Tow Control No. ____________________ |
DATE: ____________ |
Tow Crane No. _____________________ |
TIME: ____________ |
Tow Truck Service Receipt
____________________________________________________________________
LICENSEE NAME
____________________________________________________________________
TRADE NAME
____________________________________________________________________
PRIMARY BUSINESS ADDRESS
____________________________________________________________________
BUSINESS PRIMARY TELEPHONE NUMBER
Storage facility/repair location__________________________________________ Telephone # (___) _______________
Name of Customer: ________________________________________________________________________________
Customer Address: _________________________________________________ Telephone # (___) _______________
Tow Pick up Location: _________________________________________________ |
_________________________ |
Street Location |
City and State |
Tow Delivery Location: _________________________________________________ |
_________________________ |
Street Location |
City and State |
Description of Disabled Vehicle |
|
Color: ______________ Make: ____________Model ____________Year ________________Tag No.: ____________
State of Vehicle Registration: ___________________________Vehicle towed to: ______________________________
Schedule of Towing Fees
Public Tow (whether accident or impound) $100
Public Storage Service Fee: $20
Private Tow
From Accident:
Non-Accident:
Total Towing Fees Due:
Maximum: $_______________________
Maximum: $_______________________
Daily Storage Fees:Minimum: $______________________ *Maximum: $_______________________
(*Maximum rate per 24 hour period or part thereof, which period shall start when the vehicle enters the tow service storage lot to which the vehicle is towed.)
OTHER CHARGES/DESCRIPTIONS: _________________________________________________________________
________________________________________________________________________________________________
Name of Tow Truck Operator: (Print)Signature____________________________
Signature (Disabled Vehicle Operator): _________________________________________________________________
NOTE: Licensee must retain a copy of the receipt for a period of three years.