Absentee Authorization to Release and Hold Harmless Agreement
Instructions: This form must be completed in full and notarized. Fax the completed form, along with a copy of your identification and proof of ownership, to 580-355-7787. If you have questions, call 580-355-7675.
I hereby authorize Checker Wrecker Service, 1502 SW 2nd street Lawton, OK 73501, to release the following vehicle :
_____ __________________ _______________________ _____________________________
(Year) (Make) (Model) (Vin)
Only to the following person:
(Full legal name as on state issued ID)
I certify that I am the legal registered owner as reflected by the records of the State of _________, and agree to hold harmless Checker Wrecker, its employees and officers from any legal issues that may result as the result of Checker Wrecker Service following this directive.
Signed this _______day of _________, 20___
Full Legal Name_________________________________________
State of _________________, County of________________
Subscribed and sworn to before me this ___________day of ___________, __________
My commission expires: __________________ _________________________, Notary Public