Motor Vehicle Record Release and Authorization Form

TO: Wisconsin Department of Transportation

The undersigned does hereby authorize to the release and delivery of all motor vehicles driving records relating to the undersigned, including but not limited to personal information, to my current/prospective employer and its insurance agent, whose names and addresses are as follows:

Company Name: Nelson Freight Service, Inc.
PO Box 7
Peshtigo, WI 54157

Name and Address of Insurance Agent:
Spectrum Insurance Group, LLC
303 Packerland Dr, Suite C
Green Bay, WI 54303

This authorization shall continue in effect until revoked by the undersigned in a subsequent writing delivered to you.

    New HireProspective Employee