Assignments

Submit an Assignment for Repossession

25%

Financial Institution & Client Information
Information on the financial institution or client.
Date
Date of submittal.
Fields marked with a * are required.
Legal Owner/Company of Collateral*
This is the legal owner of collateral or financing company.
Fields marked with a * are required.
Legal Owner/Collateral Phone*
Direct contact phone number for legal owner/financing agency.
Legal Owner/Collateral Fax*
Fax Number for legal owner/financing agency.
Fields marked with a * are required.
Legal Owner/Company of Collateral Email*
Email address related to the legal owner or financing company.
Fields marked with a * are required.
Enter Email Confirm Email
Legal Owner of Collateral/Financing Company Address.*
The address of Financing company handling the case or collateral.
Fields marked with a * are required.

Street Address Address Line 2 City State ZIP Code
Website of Collateral Owner/Financing Company
Agent's Name*
Name of the agent submitting/working this case.
Fields marked with a * are required.
First Last
Agent's Email Address*
Email address for agent handling the case.
Fields marked with a * are required.
Enter Email Confirm Email
Agent's Fax Number
Fax Number of Agent handling case.
Agent's Phone Number
Phone number for contact of agent handling case.
Associated Account Numbers
Account Numbers associated with account, multiple lines provided in case of multiple case numbers

Debtor's Information
Information on the debtor.
Debtor's Name*
The name of the debtor.
Fields marked with a * are required.
First Last
Debtor's Address*
Address of Debtor/Collatoral

Street Address City State ZIP Code
Debtor's Address Secondary
Street Address City State ZIP Code
Debtor's Phone Number
Phone number for Debtor.
Debtor's Phone Number (Secondary)
Secondary phone number for debtor.
Debtor's Driver's License State and Number
Driver's license number of Debtor
Debtor's Social Security Number
Social Security Number of Debtor (Not Required)
Debtor's Place of Employment
Place of Employment for Debtor
Debtor's Place of Employment Phone Number
Phone number for Debtor's Place of Employment..
Address for Debtor's Place of Employment
Address of Debtor/Collatoral

Street Address City State ZIP Code
Is there a secondary debtor?*
If there is a secondary debtor you will be taken to an additional page to for us to collect their information, if not you will be taken to describe the vehicle and debt.
Fields marked with a * are required.
- Yes
- No

Co-Debtor's Information
Information on the co-debtor.
Co-Debtor's Name*
The name of the co-debtor.
Fields marked with a * are required.
First Last
Co-Debtor's Address
Address of Co-Debtor/Collatoral

Street Address Address Line 2 City State ZIP Code
Co-Debtor's Phone Number
Phone number for Debtor.
Co-Debtor's Driver's License State and Number
Driver's license number of Co-Debtor
Debtor's Social Security Number
Social Security Number of Debtor (Not Required)
Co-Debtor's Place of Employment
Place of Employment for Debtor
Co-Debtor's Place of Employment Phone Number
Phone number for Debtor's Place of Employment..
Address for Co-Debtor's Place of Employment
Address of Debtor/Collatoral

Street Address City State ZIP Code

Collateral Information
Information on the Physical Collateral.
Vehicle Year*
Make of Collateral Vehicle.
Fields marked with a * are required.
Vehicle Make*
Make of Collateral Vehicle.
Fields marked with a * are required.
Vehicle Model*
Model of Collateral Vehicle.
Fields marked with a * are required.
Color and Trim
The color and any special trim or version of Collateral Vehicle.
Fields marked with a * are required.
Vehicle Identification Number VIN*
Vehicle Identification Number VIN.
Fields marked with a * are required.
License Plate Tag Number and State*
License Plate Number and State
Fields marked with a * are required.
Number of Keys (if any)*
Number of Keys for Vechile
Fields marked with a * are required.
Key Code (If Applicable)
Key Code, if applicable.
Fields marked with a * are required.
Debt Information
Information on the financial status of collateral.
Gross Balance of Debt in USD*
Complete balance of debt.
Fields marked with a * are required.
Amount in Delinquency*
Amount of delinquent debt
Fields marked with a * are required.
Additional Notes and Comments
Additional notes and or comments
File Uploads
You may upload any files pertaining to the assignment, there is however no requirement to upload any documents.
Drop files here or

Accepted file types: jpg, docx, png, pdf, bmp, .
Name of Authorized Submittor*
Name of the person submitting this form in completion.
First Last
Electrionic Signature
Please use mouse or touch screen device to mark your signature.

Financial Institution & Client Information