American Recovery Specialists Online Assignment Form

You may always contact us at any of the following locations
CONTACT	LOCATION	PHONE	FAX
Lawrence F. Rubinosky, President	Corporate Offices P.O.Box 986 Spring Lake, NC 28390 [Covering Fayetteville Area]	910.436.4340	910.436.0191
Robin Owensby Manager	P.O.Box 667603 Charlotte, NC 28266	704.393.8733	704.393.9133
Doug Sigmon Manager	P.O.Box 49356 Greensboro, NC 27419	336.855.9332	336.855.2011
Amy Bilich Manager	P.O.Box 10565 Wilmington, NC 28404	910.792.1306	910.794.1650
Rhonda Yarborough Manager	P.O.Box 6223 Florence, SC 29501	843.678.9040	843.678.9049

Online Assignment Form

Lienholder:

Address: ......

City:.............State: Zip:..

Phone: .........Ext: .. Fax:

E-mail:..........

Collector: .....

Debtor:..

Address:..

City: .........State:Zip:.

Phone: ......

E-mail:.......

SS#: . . . . Date of Birth:

Employment:

Address: ........

City: ..............State:Zip:..

Phone:............Ext.:..Fax:

Collateral Yr, Make, Model:

License Plate: ....... . . . . ......... Color:

Door Key #:............... . ......... Ignition Key:

Vehicle Identification Number:[Be sure to include all 17 numbers]

Loan Number: ..

Past Due Date: .. .Past Due Amount: .. .

Monthly Payment: Loan Balance:

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.

Please provide information in this space:

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:

Any questions? Please contact us at 910-436-4340
Or you may also contact us via E-mail at: