Critical Safety Consent(Required) 911 Notification & Hold Harmless Agreement
I acknowledge that I am NOT in a safe location. I confirm that I have notified 911 or my local emergency services of my situation before requesting service from Road Rescue Network. I understand and agree that Road Rescue Network, its rescuers, vendors, agents, employees, contractors, affiliates, and partners bear no responsibility or liability for my safety or the safety of my vehicle and property while I am in an unsafe location, regardless of the circumstances. By checking this box, I fully release and hold harmless Road Rescue Network and its affiliates from any and all claims, losses, injuries, or damages, including bodily harm or death, that may occur before, during, or after my service request due to my being in an unsafe location.
Where is the vehicle located?(Required)
Where would you like to get towed to?(Required)
What is your name?
First
Last
Mileage & Any Additional Charges Customer Consent for Mileage and any Additional Charges (if applicable)
I acknowledge that I will be responsible for paying the tow truck driver the mileage charges of $5 per mile for the total distance towed, along with any additional costs such as tolls or special handling (if applicable) upon delivery of the vehicle.
What is the billing address associated with the card?
