Tow Company Submission Form

1: Vehicle Information

Appraised Value*

Appraised Value (Verified)*

Type of Tow*
Additional information about the vehicle

Business Information

Physical Address

Street Address*

Mailing Address

Street Address*

Phone and Email

AUTHORIZATION: I authorize Oregon Lien Source to Act on my behalf to obtain information and to give notice concerning a vehicle(s).

- By checking this box, you hereby agree to the terms stated in the 'AUTHORIZATION' section above and confirm that the information provided on this form is accurate and truthful to the best of your ability. This checkbox constitutes a digital signature, and must be checked to process this Lien Service Order.*

I agree to the terms

3: Vehicle Owner Information

(only required if vehicle owner requested tow)

Owner's First Name

Owner's Last Name

Owner's Street Address

Owner's City

Owner's State

Owner's Zip

4: Verification and Submission