Service Hold Harmless Agreement

Home
Tow Me
Payments
Service Forms
Apply Now
Contact Us

8 0 1 . 4 7 1 . 7 4 4 4

SERVICE HOLD HARMELSS AGREEMENT
(Read Carefully, Mark, Fill and Sign)

Once Your Form Is Completed, You Will See A Pop-Up Message That Says...
'Your Acknowledgement Was Sent!'

If You Do Not See That Message, Then You Are Missing One Or More Form Fields.
Check And Try Again!

SHHA Form

(Service Hold Harmless Agreement)

Please Fill Out All Form Fields

STAR TOWING

Schaefer Transport & Asset Recovery, LLC
Dba: STAR TOWING
978 North 1540 West
Orem, Utah 84057
801-471-7444

STAR TOWING - Service Hold Harmless Agreement (Personal Property, Cargo, Personal/Bodily Injury, Vehicle Exterior, Vehicle Interior, Roadside Services, Towing, Recovery, Accidents, Special Equipment, Etc.) ^*

I hereby, in consideration of the above named towing company and driver/employee(s) providing service(s), give my permission to provide the service(s) requested.

I hereby, in consideration of the above named towing company and driver/employee(s) providing service(s), release and hold harmless the towing company, and all employees of said company. I understand that such service(s) as Lock-Outs, Jump-Starts, Tire Changes, Fuel Deliveries, Special Equipment, Winching, Towing and any other service(s) involves possible risk of damage to my vehicle, and do hereby expressly accept all of the risks, damages to vehicle and incurred costs, including but not limited to personal and or bodily injury. (This also includes, prior scratches, dents, misc. damages or missing parts to vehicle)

I assume all responsibility, in consideration of the above named towing company and driver/employee(s) providing service(s), and hold harmless for any or all damage to goods stored inside vehicle as well as any issues that may arise in/from the said goods from the vehicle, including but not limited to personal and or bodily injury. Also, in consideration of the above named towing company and driver/employee(s) providing service(s), is not responsible for the condition or damage to vehicle including all external and internal components, as well as any and all cargo and will be held harmless for any damages caused thereto.

I assume all responsibility, and or am the owner and assume all responsibility of the subsequently mentioned property/vehicle. I authorize and contract in consideration of the above named towing company and driver/employee(s) providing service(s),to remediate any and all issues and or situations that have resulted to vehicle and property due to the incident I am involved in today. I understand fully that extraordinary machinery, tactics, and/or special tools could/will be necessary to clear and remediate the incident scene and/or the property damaged by the aforementioned incident. By signing this authorization form, I understand that all labors will be performed by, or hired by the above named towing company and driver/employee(s) providing service(s), and may be subject to rates above and beyond anything specified as normal towing and recovery rates due to employment of aforementioned labor, machinery, equipment, tactics, and/or special tools.

I assume all responsibility, and of the subsequently mentioned property/vehicle, and will personally cover any costs involved/incurred to the said private property, personal property and/or the vehicle(s) involved in the incident I am involved in today, if for some reason my insurance company, roadside assistance, warranty coverage and/or private provider will not cover, in consideration to the above named towing company and driver/employee(s) providing service(s), promise to settle the debt(s) in full immediately, or before property/vehicle is released.

Your signature below acknowledges, releases and holds harmless, the listed towing company and any of its driver/employee(s) from any liability resulting from the service(s) provided, and/or towing of your vehicle, and your signature is testimony that you have read and understand this statement of ‘Release of Liability’, and have no questions whatsoever, at the time this service is provided.

Please select all boxes above to acknowledge this 'Service Hold Harmless Agreement' via your device.

Customer Appearance or Presence ^*

On-Scene w/ Tow Truck - On-Site Service Only

On-Scene w/ Tow Truck - Pick-Up/Drop-Off

On-Scene w/ Tow Truck - Pick-Up Only

On-Scene w/ Tow Truck - Drop-Off Only

Not On-Scene w/ Tow Truck - Pick-Up/Drop-Off

Not On-Scene w/ Tow Truck - Pick-Up Only

Not On-Scene w/ Tow Truck - Drop-Off Only

All Arrangements Made By Phone Call

All Arrangements Made By Texting

All Arrangements Made By Email

Please select all the boxes that apply to you and your service presence or appearance.

Service(s) Provided ^*

Multiple Services (Including All That Apply)

Towing (Standard)

Towing (Trailer/Motorcycle)

Towing (Accident)

Towing (Off-Road)

Towing (Private Property Impound)

Recovery (Standard)

Recovery (Off-Road)

Jump Start

Lock Out

Tire Change or Air

Fuel Delivery (Gas)

Fuel Delivery (Diesel)

Fluid Delivery

Winching (Standard)

Winching (Off-Road)

Please select all the boxes that apply to you and your service(s) that are being provided.

PO Reference #

Please leave field blank if you are not given a 'PO' or 'Reference' number directly by your service provider.

Vehicle Owner First Name ^*

Actual titled owner 'First Name' on the vehicle, regardless if they were the one driving or not, at the time of the incident.

Vehicle Owner Last Name ^*

Actual titled owner 'Last Name' on the vehicle, regardless if they were the one driving or not, at the time of the incident.

Driver First Name ^*

'First Name' of the driver of the vehicle, at the time the incident happened.

Driver Last Name ^*

'Last Name' of the driver of the vehicle, at the time the incident happened.

Phone ^*

Please enter the phone number with dashes.
(Ex: 801-471-7444)

Email ^*

This form field must have the complete email address to complete the form.
(Ex: example@startowingutah.com)

Digital Acknowledgement Signature ^*

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 ^*

Digital acknowledgement signature date of signing.
(Ex: 8-24-2014 or 8/24/2014)

Digital Acknowledgement Signature Time Of Signing ^*

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!

GET TO KNOW US

STAR TOWING is a small company based in Orem, Utah that provides Towing, Recovery & Roadside Assistance Services. We are always striving to have the latest and safest equipment for the services you are in need of. We work hard to give you competitive prices and timely responses with pride in our services, and most of all great customer service!

GET IN TOUCH

978 North 1540 West, Orem, Utah 84057
info@startowingutah.com
(801) 471-7444
Text Us Now
24/7 - Including Holidays
Utah State & DMV Registered:
Schaefer Transport & Asset Recovery, LLC
(Dba: STAR TOWING)
Impound Yard #10237