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Locations/Coverage: Charlotte Fayetteville Florence Greensboro Wilmington
Please be prepared for one of our associates to contact you to verify the information and further discuss this assignment if we have not already done so.
Make sure you have a valid lien recorded on the title of your collateral prior to assignment
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: InvoluntaryVoluntary Field CallImpoundSkip Only
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:
