I understand that by authorizing the release of this vehicle and its contents to the above party, I thereby relieve J & J Towing and its agents, officers, and employees from the responsibility and liability for any and all claims, actions, demands, and damages, that might arise as a result of the release of this vehicle and its contents to the above party.

By signing this form, IT DOES NOT IN ANY WAY release the owner and/or owners of the responsibility for the towing and/or storage charges for the above vehicle. Per Fla Statue 713.78, in the event that the vehicle above is abandoned without the charges being paid to J & J Towing, a Wrecker Operator Lien will be placed on all of the vehicles registered owner and/or owners.

PERSON AUTHORIZED TO APPROVE WORK/CHARGES OR RECEIVING SERVICE

I certify that the information above is accurate and complete and hereby authorize the collection of payment via the above credit card for the services performed. I understand and agree to the following: Estimated charges may vary depending upon the actual conditions encountered. Should additional work be required that exceeds the estimate above, Cal-Nevada Towing (company) will obtain authorization from either the cardholder, or the person indicated above as "PERSON AUTHORIZED TO APPROVE WORK/CHARGES" prior to completing additional chargeable work. The later may indicate their approval via their signature on the Cal-Nevada Towing invoice. If the "Estimated Charges" field is left blank, I agree to pay the actual charges invoiced by company. I understand the company is entitled to compensation for work performed and equipment utilized. I authorize company to charge for travel and work actually performed if the service cannot be completed due to materially inaccurate or incomplete information being provided to company. Hourly charges begin accruing when operator(s) depart base. Cancellation of service later than 15 minutes past operator departure will result in charges for their actual port to port travel time (time spent traveling from base and back).

You must include a copy of the credit card and driver’s license of card holder . Send via fax or email 954-972-7383 – jjtow0855@hotmail.com

PLEASE LIST 3 REFERENCES THAT WE MAY CONTACT

Agreement and Guaranty

The above information is given for obtaining credit and warranted to be true. We affirm that we are financially able to meet our obligations and will remit all invoices within 30 days of Service. All invoices past due over 30 days are subject to a late fee of 15% interest and 35% collection agency charges. I/We authorize all the above name persons/businesses to release pertinent information to J & J Towing for the purpose of obtaining credit.