Vehicle Impound Invoice Template
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1
2PRINTED IN B.C.
4500308883
Vehicle Impound Invoice
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Vehicle Owner Information
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PHONE NUMBER
ADDRESS
POSTAL CODE
Vehicle Information
VEHICLE YEAR
MAKE
BODY TYPE
MODEL
VEHICLE IDENTIFICATION NUMBER (SERIAL)
COLOUR
LICENCE NUMBER
LICENCE YEAR
PROV/STATE
PROVINCE
ODOMETER READING
GAS GAUGE READING
YES
NO
YES
NO
YES
NO
YES
NO
Licence Plate (front)
Mag Wheels
Nose Bra
CD Player
Licence Plate (rear)
Foglight(s)
Keys
Clock
Air Conditioner
Roof Rack
Cell Phone
Seat Covers
Side View Mirror
Canopy
Cell Phone Holder
Radar Detector
Spotlight(s)
Trailer Hitch
Radio
No. of CDs
_______
Wheel & Covers
Rear Step Bumper
Tape Deck
No. of Tapes
_______
ADDITIONAL EQUIPMENT AND/OR CONTENTS
PRE-EXISTING DAMAGE
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Vehicle Impound Towing & Storage Rates
Item
Towing Distance
Gross Vehicle Weight
Column 1
Column 2
Column 3
Column 4
Column 5
not more than 3,000 kg
more than 3,000 kg but
more than 6,300 kg but
more than 9,073 kg
not more than 6,300 kg
not more than 9,073 kg
1
not more than 6 km
$77.46
$81.80
$129.67
$172.47
2
more than 6 km but
$77.46 + $2.64/km for
$81.80 + $3.05/km for
$129.67 + $3.72/km for
$172.47 + $7.83/km for
not more than 16 km
each km over 6 km
each km over 6 km
each km over 6 km
each km over 6 km
3
more than 16 km but
$103.86 + $2.23/km for
$112.30 + $2.79/km for
$166.87 + $3.15/km for
$250.77 + $6.71/km for
not more than 32 km
each km over 16 km
each km over 16 km
each km over 16 km
each km over 16 km
4
more than 32km
$139.54 + $1.93/km for
$156.94 + $2.28/km for
$217.27 + $2.53/km for
$358.13 + $4.82/km for
each km over 32 km
each km over 32 km
each km over 32 km
each km over 32 km
Towing Surcharges
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IMPOUND LOT NAME
Fuel Surcharge 12% of the towing cost.
$0.43 per km for the use of dollies when the distance travelled
ADDRESS
exceeds 32 km while on a paved highway.
$0.63 per km for the use of dollies when the distance travelled
exceeds 32 km on an unpaved highway.
POSTAL CODE
PHONE NUMBER
Invoice
ICBC SUPPLIER NUMBER
TOW TRUCK DRIVER’S NAME
(PLEASE PRINT)
DAY
MONTH
YEAR
DATE VEHICLE PICKED UP
Number of Days ____ X $___________ =
$
Towing Charges =
$
Administration
Claimed Vehicle $35.05
$
Fee
or
$
Unclaimed Vehicle $70.09
Sub Total
$
GST
$
TOTAL
$
SEE BACK OF FORM FOR STORAGE RATES
White – Impound Lot Operator
Canary – Vehicle Owner Receipt
Pink – Vehicle Owner/Driver
MV2714 (03/2016)
4500194331
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