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<br /> AO�HO��T Q�N_FORM
<br /> �. he=eby authazize the
<br /> (we.s �c c.r! '
<br /> r�.: '_�.i:.�� of the moZor vQhicl,e, ' ,
<br /> ,� . � ca.wi.e..l�r..sf
<br /> v=`i� ' � � � , Lic�nse �
<br /> .
<br /> cu�-,:ncZy stcred by Prairialand Towiuq, � Inc. , to
<br /> ��. • I nat the Ieqal vwner of such
<br /> c=...�
<br /> vez:�'_,�, and am unable to pick up� ths same due to my .
<br /> �._ � at �
<br /> ;:,..u�_r�t:oa. aespiLallsaL'os. �te.l tsso� K inscir�oo) •
<br /> t �::�:E_st�d thac stora e and/o= towin costs are accruin and have
<br /> g . g g
<br /> ac��uc�!, for which I a,m liabla. I further understand tha.t
<br />, Pr��-:i.�land Towing, Inc. shall z�quire payment 'o� such costs in
<br />' fL '_'_, :,rior to the person nam�d heroin, being allowad to retrieve
<br /> s:_�. ��;!�ic1a. I understand that ia the �vent that the person aamed
<br /> r�=���_r_ .�s my aqent should procure the release of my vehicle through
<br /> i_,:::::u�.;zt or dc:ceptive meaas (i.A. , insufticient �unds check, stop �
<br /> p,::�:..�r.�., etc. ) that any remedy wh��h Prairieland Towing, Inc. , may
<br /> h�•:�� t;: enforce tha col�ection oP that amount, against the maker,
<br /> i.� :::1�:1 aLso rave aqainst me, includinq the coll,ection of any
<br /> cc��::: �_ attvrncy's feas from the same.
<br /> r sbsolve, indemni•fy, �aleas�, quit claim, and hold harm2esa
<br /> P:�.`. ::,:'snd Towinq. Inc . , trom any aad a11 camaqes, lvsses,
<br /> ac.:: ���=::�.:s or theft, which m�ay oceiar as a result o� the release of
<br /> ar.•r �f.:�::.c:jt� to tha person nemed he=ein. Prairielazd Tvwinq, Ync. ,
<br /> ms_� . •':r upon�.any pictu�e fo�aro,t �identification, when det�rmining
<br /> �, �,• � � . . .
<br /> ' �e,;� . , � . , . . � ; . . . • -
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<br /> I P�IB�T F
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