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
6/5/17jr
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
WINCHING, TOWING OR TEMPORARY EMERGENCY ROADSIDE SERVICE OF ANY KIND TO MY VEHICLE
Please be advised that I authorize A Toe Truck to winch, tow or provide temporary emergency service to my vehicle. I realize that A Toe
Truck might have to use extraordinary equipment, services and personnel to winch, tow or provide temporary emergency service to my
vehicle. I realize that A Toe Truck will remove the vehicle from the State’s property and/or other private property. I also understand that it is
my obligation to seek further professional assistance as soon as possible at a licensed facility to minimize any issues or damage to my vehicle
in the future as this is only for temporary emergency roadside service. Any wheel/tire replacement is considered a temporary emergency
roadside service, it is your responsibility to seek professional assistance as soon as possible at a licensed tire shop. _______________
Customer Initial
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 winch & or tow my vehicle, clean-up and restore the property to its
previous condition. All rates for services, winching, towing, recovery, clean-up, available for you upon your request per (California Vehicle
Code Section 22651.07).
Hold Harmless
I further represent, covenant and warrant that I am the registered and/or legal owner of the above- identified vehicle and hereby agree to
indemnify and hold harmless A Toe Truck A Division of “West Ventures Inc.”, it’s departments, officers, boards and employees from and against
any claim, debt, liability, demand, obligation, cost, expense, personal injuries, bodily harm, dismemberment, action or damages of
whatsoever kind or nature arising out of, or in connection with the service that will be provided.
I REPRESENT THAT I HAVE READ THE ABOVE AUTHORIZATION/HOLD HARMLESS AND FULLY
UNDERSTAND ITS CONTENTS.
**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
Tow Winch Wheel/Tire Jump Start Lock Out Fuel Gas Diesel
(Circle One)
Person in charge of vehicle information:
Vehicle Identification Number: ___________________________________________________________________________
Vehicle Plate Number: ______________________________________ Vehicle Plate State: __________________________
Year: ______________ Make: _____________________________ Model: _______________ Color: ________________
By signing below, I have read and fully understand this document.
Date: _________________________________________________________ Time: __________________________________
Signature: _____________________________________________________________________________________________
