Scofield's Towing Inc.

Service Provider# Date / Club /ect./ PO#ect. Vehicle Description / Located at / Deliver to / Passengers / 1 / 2 / Miles to / / minus miles/ actual / Miles loaded / / minus miles/ actual / Towing / Load up, Unload Charge Jump start / Unlock / Fuel / Flat / Air / GOA / wheel-lift / Winch / Time on job by the 1/2 hour min. Waiting on Police / Report # Clean up accident scene / Time / Extra Equip. / Skates / Dollies / Boards / Soap / Administrative Fee / Storage fee/
I agree to hold Scofield's Towing Inc. & its employee's harmless for any damage's due to services rendered, and will pay the listed charges for services rendered, minus any accepted motorclub coverage, in full at that time, before vehicle is unloaded, or vehicle will be held for listed charges, plus storage charges, that may accrue, & charges of theft of services will be filed. This must be signed before work will start. Tax Total

608-921-0726 Time / AM / PM / Membership #

Driver / ETA /

Coverage limit /

$ $ $ $ $ $ $ $ $ $
$ $

Subtotal $

Accepted by: Customer / Phone # Address / Vehicle Lic. # Driver Lic.# Vin #

Payment is cash, MasterCard, & Visa only.

State State State

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