Agency/Police Disposal Liens - Under $500 Value
Company Name
Mailing Address
Storage Address
Fax
Zip
Zip
Phone
City
City
1.
Year
Make
Model
VIN#
St
Lic/CF
Date Of Poss
Stg Per Day
Tow Charge
Motorcycles And ATVs, We Must Have The Engine Numbers - We Cannot Process A Lien Without Them. Please Be Accurate!!
Agency-City-Zip
2.
Year
Make
Model
VIN#
St
Lic/CF
Date Of Poss
Stg Per Day
Tow Charge
3.
Year
Make
Model
VIN#
St
Lic/CF
Date Of Poss
Stg Per Day
Tow Charge
4.
Year
Make
Model
VIN#
St
Lic/CF
Date Of Poss
Stg Per Day
Tow Charge
5.
Year
Make
Model
VIN#
St
Lic/CF
Date Of Poss
Stg Per Day
Tow Charge
Hull / Eng #
Hull / Eng #
Hull / Eng #
Hull / Eng #
Hull / Eng #
I certify under penalty of perjury under the laws of the State of California, that the information I have provided is true and correct.
Date
Signature
Printed/Typed
X
To Fax, Print (Ctrl+P) This Page And Fax To 510-799-1456
Thank You Very Much for the order!! The ASAP Team
<---Click here to Submit This Order and Start a New Order.
By clicking the "Submit" button below or printing, and faxing or emailing, you confirm that you have read and agree to the terms and conditions set forth above.
Be Sure To Print A Copy For Your Records!!
6.
Agency-City-Zip
Fax To 510-799-1456
Agency-City-Zip
Agency-City-Zip
Agency-City-Zip
PLEASE USE CAPS
If You Know Your ASAP Acct #, Enter It As The Company Name And Proceed To The 1st Vehicle Information.
When you submit this form to ASAP Lien Sales, Signed Or Not, It Is A Binding Contract. This form authorizes a lien to be processed by ASAP Lien Sales with the information you provide, and that you will hold ASAP Lien Sales harmless from any lawsuits, judgments, omissions or errors of any kind and under any circumstances. ASAP Lien Sales Is Providing A Secretarial Service To You And Will Be Liable For The Cost Of The Lien Sale Processing Only.
