Repossessions and Recovery by American Recovery Corporation.Assignment Form

Assignment Form

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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.

Lienholder: Enter Lienholder

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Email: Enter Email

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Address: Enter Address

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City: Enter City

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Phone: Enter Phone

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Extension: Enter Extension

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Fax: Enter Fax

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Please Read: PLEASE READ: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.

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Collector: Enter Collector

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State: Enter State

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Zipcode: Enter Zipcode

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Debtor: Enter Debtor

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Address: Enter Address

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City: Enter City

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State: Enter State

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Zipcode: Enter Zipcode

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Phone: Enter Phone

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Extension: Enter Extension

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Fax: Enter Fax

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Email: Enter Email

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Soc. Sec.#: Enter Soc. Sec. #

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Date of Birth: Enter Date of Birth

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Co-Debtor: Enter Co-Debtor

Address: Enter Address

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City: Enter City

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State: Enter State

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Zipcode: Enter Zipcode

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Phone: Enter Phone

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Extension: Enter Extension

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Fax: Enter Fax

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Email: Enter Email

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Soc. Sec.#: Enter Soc. Sec.#

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Date of Birth: Enter Date of Birth

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Employment: Enter Employment

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Address: Enter Address

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City: Enter City

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State: Enter State

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Zipcode: Enter Zipcode

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Phone: Enter Phone

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Extension: Enter Extension

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Fax: Enter Fax

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Year: Enter Year

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Make: Enter Make

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Model: Enter Model

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Color: Enter Color

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Plate #: Enter Plate #

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State: Enter State

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Key Numbers: Enter Key Numbers

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Vehicle Identification Number: Enter Vehicle Identification Number

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Loan #: Enter loan #

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Monthly Payment: Enter monthly payment

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Loan Balance: Enter loan balance

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Assignment Type: Select One, Involuntary, Voluntary, Contact & Collect, DMV, MVR

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Information: Please provide information in this space:

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Authorized by: Enter name of person making authorization

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Date: Enter date

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Email form to: Enter email address to receive a copy of this form

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Image Verification:

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Attention:

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