Private Impound Application

Please print and fax this form or simply complete the form below and fax it into our offices.

Please fill out the application below and one of our agent will get in touch with you in the next 24 hours.

General Information
Property Name*
Management Company
Contact First Name*
Contact Last Name*
Desired Web-Access Username*
This will be used to view tagged car pictures.
Address*
Street AddressCityZip Code
Cross Streets
Gate Code
Contact Information
Manager/President Name
Phone
Fax
Email
Additional Authorized Agents / Board Members
Additional Authorized Members (One per line)
Please use: Name, Position, Phone
Services Provided
Services Provided
- Walk & Tag Program
- Parking Pass Program
- Current use of Parking Permits
- Parking Permit Program
- Immediate Red Zone Removal
- Immediate Handicap Removal
- Immediate Landscaping Removal
- Immediate Illegally Parked Removal
- Immediate Backed-In Removal
Walk & Tag Information
I, ____________ am requesting the Walk & Tag services be performed on the property.*
Please sign your name above
All vehicles in violation will be tagged for ______ hours before they are removed. The Walk & Tag program is performed once a month unless otherwise requested.*
Please include number of hours above
By initialing here you understand that no vehicle(s) will be removed from the property without approval from an authorized agent of the property.
Please initial above
By initialing here you understand that the tag list is to be signed and dated before vehicle(s) removal
Please initial above
By initialing here you authorize Century Towing and employees to enter your property after hours and perform the Walk & Tag Program.
Please initial above
By initialing here you understand that the tag list is to be signed and dated before vehicle(s) removal
Please initial above
Immediate Removal Authorization
I, ____________ authorize and request Century Towing to immediately remove any vehicle(s) in the violations I initial below:*
Initial here to authorize Century Towing to immediately remove any vehicle(s) within 15 feet of a fire hydrant
Please initial above
Initial here to authorize Century Towing to immediately remove any vehicle(s) parked in a fire zone/red zone
Please initial above
Initial here to authorize Century Towing to immediately remove any vehicle(s) blocking an entrance or exit
Please initial above
Initial here to authorize Century Towing to immediately remove any vehicle(s) illegally parked in a handicap space
Please initial above
*Please Note: All Vehicles that are immediately removed will ALWAYS be accompanied by digital photographs that clearly indicate the vehicle’s infraction(s).

Private Impound Application

Private Impound Application

General Information

Contact Information

Additional Authorized Agents / Board Members

Services Provided

Walk & Tag Information

Immediate Removal Authorization

Contact Info