Vehicle Release Form

Date ___/___/___

I, _______________________________ would like to release my,

Year_______ Make_________________ Model________________

Vin#__________________________  License Plate______________

Drivers License #_______________ Insurance Company___________________

Policy #________________

I, _________________________________ authorize release of my vehicle to

(RO or Agent) _________________________________ and release Blairs from any

and all liabilities from this moment.

Signature_________________________ Phone #(     )____-______

Attach Copy of Drivers

License here