7070 Smith Road Denver CO 80207
Phone: 303-295-6353 Fax: 303-292-0508
PUC-T 2625 www.maxxautorecovery.com
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Make: Model: Color: Lic #/State:
Property Name:
Complete Address:
Impound Lot Address: 7070 Smith Road, Denver CO 80207
AUTHORIZING AGENT MUST PRINT FULL NAME TO BE VALID
Print name:
Authorizing Agent’s Title:
If no plates, please provide VIN _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Any comments (please advise of condition of vehicle, i.e. flat tires, wrecked, etc.)
Reason for Impound:
Signature below indicates you are the authorized agent and/or owner of said property. Only 1 vehicle can be removed per request (this form). We are not responsible for any subsequent damages to your property necessitated by the removal of any vehicle. Signage is available upon request, free of charge to you. We recommend the placement of restricted parking signs on your property properly warning people against parking their vehicles without proper authorization.
Signs are required within Denver city limits. All vehicles will be disposed of in a manner consistent with the rules and regulations concerning abandoned vehicle processing for the State of
Colorado. All rate maximums are set by the PUC. All vehicles removed will be charged back to the vehicle owner at the maximum rate allowed by those rules. Each vehicle that is removed is reported to the local PD or Sheriffs office as required by law. A case number is generated for each vehicle removed and said number and all required paperwork will be kept in our files and available upon request for 3 years from the date of the impound. We retain the right to refuse tow on any abandoned vehicle at any time. Your signature below indicates you have read and understand this document in its entirety and are granting authorization for the removal and proper disposal of the aforementioned vehicle
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PHONE NUMBER:
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