DD#__________
A TOE TRUCK
A DIVISION OF "WEST VENTURES INC"
P.O. BOX 3142
PARKER, AZ 85344
CORP OFFICE: 928-669-5600
FAX: 928-669-2126
Revised Toe Form 101-A 1/23/17jr
West Ventures Inc. is an Arizona S-Corporation doing business as A Toe Truck
GOVERNING LAW: The terms of this Agreement shall be constructed in accordance with the governing law of the State of Arizona, County of La Paz.
CONTRACT FOR THE RECOVERY, TOWING AND STORAGE OF VEHICLES AND CARGO
Please be advised that I authorize A Toe Truck to recover my damaged vehicle(s). I realize that A Toe Truck might have to use
extraordinary equipment, services and personnel to recover, tow and store my vehicle and/or cargo, as well as to clean-up the accident
scene. I also realize that A Toe Truck will remove the vehicle(s) and /or cargo from the State’s property and/or other private property.
I understand that the vehicles and cargo cannot be left on the state or private property because it impairs the use of the property and
poses a general safety hazard to others. Therefore, in order to minimize the damages caused to the property and to avoid any further
damage to persons or property and avoid additional costs, I authorize A Toe Truck to recover vehicles, clean-up and restore the
accident scene to its pre-accident condition, remove the vehicles and cargo from the scene and store them at prevailing rates. All rates
for towing, recovery, clean-up, restoration and storage are available for you upon your request per (California Vehicle Code Section
22651.07).
**Information in this box is to be filled out by Driver ONLY**
Extra ordinary equipment used:
___ Light Duty Class A ___ Medium Duty Class B ___ Heavy Duty Class C ___ Super Heavy Duty Class D
___ Service Truck ___ Special Heavy Equipment (Low Bed, End Dump, 4x4, Wheel Loader, Bobcat, Forklift )
____ Laborers
Storage Facility:
___ 500 S. Hopi Ave, Parker, AZ 85344 ___ 1210 N. Central Blvd, Quartzsite, AZ 85346
___ 44601 HWY 95, Salome, AZ 85348 ___ 2070 Courtwright, Mohave Valley, AZ 86440
___ 518 W Broadway, Needles, CA 92363 ___ 701 E. Broadway, Needles, CA 92363
___ 50400 Parker-Ehrenberg HWY, Ehrenberg, AZ 85344
Person in charge of vehicle information:
Vehicle Identification Number: ___________________________________________________________________________
Vehicle Plate Number: ______________________________________ Vehicle Plate State: __________________________
Year: ______________ Make: _____________________________ Model: _______________ Color: ________________
Name (print): __________________________________________________ Affiliation: ______________________________
Company Name: _______________________________________________________________________________________
Address: ______________________________________________________________________________________________
Phone#: _______________________________________________________________________________________________
Insurance Name: ________________________________________________ Claim#: ________________________________
I authorize A Toe Truck to store the vehicle(s) and/or cargo at their facility, which is marked with an X above.
By signing below I have read and fully understand this document.
Date: _________________________________________________________ Time: __________________________________
Signature: _____________________________________________________________________________________________
