auto repo, recovery, repossession, peoria, illinois, repo, central illinois

Bill Greene
President

[PLEASE NOTE: " * " before a title indicates a 'required' field.
This must be filed out prior to submission]


*Lien Holder:
*Address
*City:
*State:	*Zip:
*TN:
*Collectors Name:
*Collectors TN:
Collectors Fax:

*Debtors Name:
*Address:
*City:
*State:	*Zip:
*TN:
*Debtors SSN:
*Debtors Date of Birth:

Comakers Name:
Address:
City:
State:	Zip:
TN:
Comakers SSN:
Comakers Date of Birth:

*Collateral: - Year
*Make:
*Model:
Color:
*VIN:	[Be sure to include all 17 numbers]
License Plate Number:
2 Door or 4 Door:

*Loan Number:
Past Due Date:
Monthly Payment:
Loan Balance:
Date of Last Payment:
Assignment Type:

Any additional information that will be valuable in locating collateral?
Please provide information in this space:
This is your authorization to act as our agent to repossess, on sight, the above described collateral, which is covered by a defaulted installment contract. We agree to indemnify and save you harmless from and against all claims, damages, losses and actions resulting from or arising out of our efforts to repossess the above described collateral, except, however, such as may be caused by or arise out of the negligence or unauthorized or illegal acts of your firm, its officers, employees or agents.
Authorized by:
Date: