First & Last Name:*
Street Address
City
Province BC
Postal Code
Cell Phone
Day Phone
Email address:*
Make
Model
Year
Kilometres Under 50,000 50,000 - 75,000 75,000 - 100,000 100,000 - 125,000 125,000 - 150,000 150,000 - 200,000 200,000+
VIN = Vehicle Identification Number. If this data is not available now, submit form and we will collect it on pickup This information can be found on your Registration papers.
License Plate Number
Do you have the Registration Papers? What are the name(s) written on title? Any liens on title?
Registration up to date? Last year paid?
Running Condition Select How It Runs Very Good Good Fair (some problems) Poor Doesn't Run
Running Condition Description
When last running well? Known problems or observed problems. Any estimates of repair cost.
Paint, rust, dents, broken parts. DAMAGE: part(s) damaged / extent of damage(s)
Upholstery, carpets, instrument panel, a/c working etc. Describe damage or non functioning parts.
If location is different than the above address please provide street address, City Also name and phone number of contact if available.
Prove you are a human: What color is our tow truck in our logo at the top of this page?
