Mesilla Valley Regional Dispatch Authority

Date

Tow Company*

Towed From Address*

Towed From City

Towed From Zip*

Tow Type

License Plate Number*

Personalized or Specialty Plate Type

License Plate State*

Vin Number

Vehicle Color*

Vehicle Year

Vehicle Make*

Vehicle Model

Vehicle Registered Owner*

Does the R/O know the vehicle is being towed?

Wrecker Driver Name*

Wrecker Company Contact*