Vehicle Release

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Vehicle Owner Information

Name*

Phone

Driver's License #**

Driver's License Photo*

Please upload a clear photo of your driver's license.

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 4 MB.

Address*

Street Address City State / Province / Region ZIP / Postal Code

Motor Vehicle Information

Year*

Make*

Model*

Color*

VIN #*

Vehicle Registration Photo*

Please upload a clear photo of your vehicle's registration.

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 4 MB.

Authorized Person/Company

Name of Authorized Person or Insurance Company*

Phone*

Claim Number (if applicable)*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Acknowledgement

I hereby certify that I am the legal owner of the above listed motor vehicle, and thus authorize the release of said vehicle to the above specified Authorized Person(s) and/or insurance company, and/or agent thereof.*

Vehicle Owner Signature

CAPTCHA

102B Pond
St. Seekonk, MA 02771

101 Commercial Way
East Providence, RI 02914

181B Knight St
Warwick, RI 02886

(401) 228-6200