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Name
*
First
Last
Phone
*
Email
*
Service Address
*
Please provide the location of the vehicle. If you are broken down and do not know where your vehicle is, please use our
Find My Location
tool to determine your approximate address.
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Drop Off Address
*
Please provide the location where we should drop off the vehicle.
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What Issue(s) Are You Experiencing?
*
Choose up to 3 that apply to your vehicle. Simple answer is, we don't want to send a tow truck to help with a simple jump start.
Flat Tire - Have a Spare
Flat Tire - Don't Have a Spare
Car Won't Start & No Dash Lights
Car Won't Start & Dash Lights are On
Just Transporting Car - It Runs
Just Transporting Car - Doesn't Run
Needs a Tune Up
I Don't Know What's Wrong
Other
What's wrong with your vehicle?
*
Please provide a simple explanation of the issue you're experiencing, and if your vehicle is front wheel drive, rear wheel drive, or AWD.
Does the vehicle have a valid tag and insurance?
*
Yes
No
Vehicle Tag/Plate # (Optional)
Hidden
Vehicle Identification Number (VIN)
Are you going to be with the vehicle?
*
If you are not, you must leave keys or we will not tow your vehicle.
Yes
No
Did you leave the keys with the vehicle?
*
If not, we will have to drag the car. Please reach out via text letting us know this.
Yes
No
Hidden
Drivers License
*
Please upload an image of your drivers license. We need a copy of your ID so we can verify you as the owner of the vehicle.
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, bmp, Max. file size: 5 MB.
Drivers License
*
Please upload an image of your drivers license.
Upon signing this agreement, I have been advised that my vehicle and or equipment or building or property, myself or other passengers, or surrounding structures, may be damaged if winched, towed, unlocked, riding along, serviced, or left on unattended premises. I understand that Southern Style Towing does not allow any riders there are exceptions due to some motor clubs and insurances that force Southern Style Towing per there contract to allow such ridders. I agree as a rider that Southern Style Towing or its employees are not responsible for any riders including accidents that are our fault or not our fault that arise in me as the customer or my passengers getting hurt in anyway shape form or fashion this includes but not limited to me not wearing a seat belt, falling in or out of truck, or any other injury that can occur as I’m ridding at my own risk. I also agree that if I have passengers that must ride also I the owner of the car being towed is solely responsible for them even if they are of age or underage. Any injuries or damages will be the sole responsibility of the motor club or your insurance as Southern Style Towing or its employees will not be responsible. I recognize the difficulty involved and I agree to not hold the towing company or its employees responsible for any such damage should it result from any of the services provided. I understand the risk and agree that any damage done to me my passengers or my property or someone else’s property will be at my own expense to repair. If this is for a portable building or any other equipment same rules apply the tow company will not be responsible for any damages done to your property, this includes but not limited to (scratches, dents, dings, ruts in grass, gutters, tree limbs, power lines, septic tanks, water lines, all damages etc.) I understand that I have the right to refuse using Southern Style Towing and have my motor club, insurance dispatch out another company if I do not agree to these terms.
Signature
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