Vehicle Surrender Form

Complete the ownership affidavit and voluntary surrender information below. Chain Gang Towing may require photo identification, proof of ownership, lien release, registration, bill of sale, or notarization before accepting a vehicle.

This form is not a substitute for a New Jersey title where a title is legally required.

Complete every required field, review the legal acknowledgments, and submit your electronic signature. A copy is securely stored and emailed to Chain Gang Towing.

Questions? Call (908) 642-3699.

Full Legal Name

Date of Birth

Driver License / State ID Number

Issuing State

Street Address

City, State and ZIP

Phone Number

Email Address

Vehicle Year

Vehicle Make

Vehicle Model

Vehicle Color

VIN

Plate Number / State

Odometer Reading

Keys Provided

Vehicle / Pickup Address

Reason Title Is Unavailable

Amount Paid (if applicable)

Other Terms / Notes

Owner Certification and Legal Acknowledgments

I certify that I am the lawful owner or authorized person; I voluntarily surrender/transfer the vehicle; Chain Gang Towing may tow, store, repair, dispose of, sell, salvage, or process it as permitted by law; the vehicle is not stolen and has no undisclosed lien, loan, lease, court order, police hold, insurance restriction, or ownership dispute; I agree to indemnify and hold Chain Gang Towing harmless from claims arising from inaccurate information; and I understand false information may create civil or criminal liability.

Electronic Signature — Type Full Legal Name

Signature Date

Signature Time

Vehicle Surrender Form

Vehicle Surrender Form

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