Vehicle Release Form

Date

FIRST - MIDDLE NAME - LAST NAME *

Address *

Phone Number *

Your E-mail *

I authorize the release of my vehicle to my friend/family-member/Insurance company/Bank/Other and take responsibly of the vehicle thereof *

Yes: Release to Friend

Yes: Release to Family member

Yes: Release to Insurance Company or their partners

Yes: Release to Bank

Yes: Release to OTHER

Name of Person or Company taking the vehicle *

YEAR-MAKE-MODEL OF CAR *

Note to Repair shop if any

Verification Code *

Marlboro Auto Repair, Tire & Collision