REPOSSESSION ORDER

Date

MM		/
DD		/
YYYY
Assignment Type
 Involuntary Reposession 
 Voluntary Repossession 
 Door Knock 
 Condition Report 
 90 Day Letter Delivery 
 Other 
Your Company Name:
Your Name
Prefix
First
Last
Suffix
Email
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Phone Number

###		-
###		-
####
Fax Number

###		-
###		-
####

Debtor Information

Account Number:
Debtor's Name:
Prefix
First
Last
Suffix
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Phone Number

###		-
###		-
####
Social Security Number
D.O.B

MM		/
DD		/
YYYY
Driver's Licence #
Place of Employment
POE Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
POE Phone Number

###		-
###		-
####
If there is a co-signer on this account please list information here.

Asset Information

V.I.N
YEAR
Make
Model
Color
Plate #

Delinquent

Delinquent Since
Past Due Balance:
Balance Due:
If contact with debtor would you like us to collect past due balance to cancel this order, plus our fee (half the repo fee) *
 Yes 
 No 

Additional Information

Other info that might help us

Please Specify Delivery Location and Storage Instructions

HOLD HARMLESS AGREEMENT
This is your authorization to process for collection, location, or repossession of the above described assignment. We agree to indemnify and save you harmless from and against any claims, damage, losses, and action resulting from or arising out of your efforts to collect, locate or repossess the above claim, except, however such as may because or arises out of negligence or unauthorized acts of your company, it’s officers, employees, or the officers or employees of such agents.
ENTER YOUR FULL NAME *
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