Private Impound Application

Please print and fax this form or simply complete the form below and fax it into our offices.

Private Impound Application

Please fill out the application below and one of our agent will get in touch with you in the next 24 hours.
  • General Information

  • This will be used to view tagged car pictures.
  • Contact Information

  • Additional Authorized Agents / Board Members

  • Please use: Name, Position, Phone
  • Services Provided

  • Walk & Tag Information

  • Please sign your name above
  • Please include number of hours above
  • Please initial above
  • Please initial above
  • Please initial above
  • Please initial above
  • Immediate Removal Authorization

  • Please initial above
  • Please initial above
  • Please initial above
  • Please initial above
  • *Please Note: All Vehicles that are immediately removed will ALWAYS be accompanied by digital photographs that clearly indicate the vehicle’s infraction(s).