Friday, September 22, 2017

Assignments


LIENHOLDER INFORMATION
Lienholder Name
Address
City
State      Zip   
Phone      EXT   
Fax
Email
Collector
DEBTOR INFORMATION
Debtor Name
Address
City
State      Zip   
Phone      EXT   
Fax
Email
Social Security Number      Date of Birth   
EMPLOYMENT INFORMATION
Employer Name
Address
City
State      Zip   
Phone      EXT   
Fax
COLLATERAL INFORMATION
Collateral Year, Make & Model
Plate, State and Color
Key Numbers
Vehicle Identification Number
LOAN INFORMATION
Loan Number
Past Due Date
Monthly Payment      Loan Balance   
ASSIGNMENT INFORMATION
Assignment Type
Note: Should you have any information regarding family members, relatives of the debtor, or any
unique or defining information that would be helpful in aiding us in the recovery of your vehicle,
please enter that information in the Instructions space below.
Information & Instructions
This is your authorization to act as our agent to collect or repossess the above collateral. We agree
to indemnify and hold you harmless from and against any and all claims, damages, losses and
actions including reasonable attorney fees, resulting from and arising out of your efforts to collect
and or repossess claims, except, however, as such may be caused by or arise out of negligence
or unauthorized acts on the part of you, your company, its officers, employees or its agents.
Authorized by      Date