(Service Hold Harmless Agreement)
Please Fill Out All Form Fields
Schaefer Transport & Asset Recovery, LLC
Dba: STAR TOWING
978 North 1540 West
Orem, Utah 84057
Please select all boxes above to acknowledge this 'Service Hold Harmless Agreement' via your device.
Please select all the boxes that apply to you and your service presence or appearance.
Please select all the boxes that apply to you and your service(s) that are being provided.
Please leave field blank if you are not given a 'PO' or 'Reference' number directly by your service provider.
Actual titled owner 'First Name' on the vehicle, regardless if they were the one driving or not, at the time of the incident.
Actual titled owner 'Last Name' on the vehicle, regardless if they were the one driving or not, at the time of the incident.
'First Name' of the driver of the vehicle, at the time the incident happened.
'Last Name' of the driver of the vehicle, at the time the incident happened.
Please enter the phone number with dashes.
This form field must have the complete email address to complete the form.
Please use your complete full name.
(Ex: John Turner Doe = First, Middle and Last)
Your digital signature here is considered legal and contractually binding.
Please enter you digital signature, whether you are the owner, or the driver, of the vehicle.
Digital acknowledgement signature date of signing.
(Ex: 8-24-2014 or 8/24/2014)
Digital acknowledgement signature time of signing.
(Ex: 11:59AM or 11:59 AM)
Thank you for taking the time to fill-out our form!
Have a great day!