Customer & Vehicle Information

Car Make & Model *

Year *

Color *

Lic. Plate *

VIN# *

Date and Time *

First Name *

Last Name *

Street Address and Postal Code *

City *

Phone Number *

Email Address *

Reason for tow: *

Pickup Address: *

Drop-Off Address: *

FEES

Wait Time At CRC $60/hour

Mileage over 20kms $3.35/km

NOTES FOR FEES:

NOTE: I understand that the $72.50 security tow to safety will be included in the charges to my insurance company.

Key #

Truck Operator Name *

Truck Operator Signature *

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DATE * +

Customer Name *

Customer Signature *

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DATE * +