Kelly Towing — Vehicle Release Request

Vehicle information

VIN

Year, make, and model will fill in automatically once a valid VIN is entered.

License plate

No plate / unknown

Plate state

Year *

Make *

Model *

Color *

Impound / case number

How is this vehicle being released?

Select the option that applies.

Owner / authorized pickup

The owner or a designated person is coming to pick up the vehicle.

Insurance company

The vehicle is being released to an insurance carrier or adjuster.

Towed out

Another tow company will be dispatched to remove the vehicle.

Please select a release type to continue.

Registered owner

First name *

Last name *

Date of birth *

Driver's license # *

Street address *

City *

State *

ZIP *

Who is picking up?

I am the registered owner and will pick up the vehicle myself

Contact

Phone *

Email *

Notes

Vehicle requirements

To drive this vehicle off the lot, the following are required by law:

Valid vehicle registration
Valid auto insurance
Licensed driver operating the vehicle

I confirm the vehicle has valid registration and insurance, and will be driven by a licensed driver

I do not have valid registration, insurance, or a licensed driver

Please select one of the options above to continue.

Insurance company

Insurance company name *

Claim number (optional)

Policy number (optional)

Adjuster / representative (optional)

First name (optional)

Last name (optional)

Direct phone (optional)

Email (optional — phone or email)

Estimated pickup date (optional)

Registered owner (for records)

Owner first name *

Owner last name *

Owner phone *

Owner email (optional)

Owner's driver's license — photo or scan *

Click to upload or drag and drop

JPG, PNG, or PDF • Max 10MB

Remove

Please upload a photo or scan of the owner's driver's license.

Personal property & liability waiver *

When a vehicle is released to an insurance company, Kelly Towing is not responsible for any personal property, valuables, or license plates that remain in or on the vehicle at the time of release. You must select one of the following options before this form can be submitted.

I have removed all personal property from the vehicleAll contents, valuables, and the license plate have been retrieved prior to release. Kelly Towing bears no responsibility for any remaining items.

I am releasing Kelly Towing from all liabilityI understand that personal property, valuables, and the license plate may remain in or on the vehicle and I release Kelly Towing, its employees, and agents from any and all liability for loss, damage, or theft of those items upon release to the insurance carrier.

I have read and understand the above statement and agree to its terms. *

Please select an option and check the acknowledgment box.

Notes (optional)

Receiving tow company

Company name *

Company phone *

Tow license # (optional)

Driver information

Driver first name *

Driver last name *

Driver's license # *

Driver phone *

Estimated arrival (optional)

Destination

Destination address *

Purpose of transfer (optional)

Registered owner (for records)

Owner first name *

Owner last name *

Owner phone *

Owner email (optional)

Owner's driver's license — photo or scan *

Click to upload or drag and drop

JPG, PNG, or PDF • Max 10MB

Remove

Please upload a photo or scan of the owner's driver's license.

Personal property & liability waiver *

When a vehicle is towed out, Kelly Towing is not responsible for any personal property, valuables, or license plates that remain in or on the vehicle at the time of release. You must select one of the following options before this form can be submitted.

I have removed all personal property from the vehicleAll contents, valuables, and the license plate have been retrieved prior to release. Kelly Towing bears no responsibility for any remaining items.

I am releasing Kelly Towing from all liabilityI understand that personal property, valuables, and the license plate may remain in or on the vehicle and I release Kelly Towing, its employees, and agents from any and all liability for loss, damage, or theft of those items upon tow-out.

I have read and understand the above statement and agree to its terms. *

Please select an option and check the acknowledgment box.

Notes (optional)

Review the information below before submitting. Use the Back button to make corrections.

Final acknowledgment

I certify that all information provided is accurate and complete. *

I understand all fees and storage charges must be paid in full before release. *

I understand valid government-issued ID and proof of ownership are required at pickup. *