A Subsidiary of SEIR, Inc. LRS of GA. In the Recovery Business Since 1990.

 

Online Repo Assignment Form

assignment type

involuntary voluntary contact & collect condition report skiptrace 

client/leinholder information
client number: 
lienholder:  
address:
city: 
state: 
zip code:
phone: 
fax: 
email: 
contact: 

debtor/loan information
loan number: 
obligation type:   security sales lease rental 
debtor:  
address:
city: 
state: 
zip code:
phone: 
date of birth: 
sex:  male  female
social security # : 
DL state: 
DL #: 
phone: 
employer: 
employer address: 
employer phone: 
other debtor info: 
co-maker info: 

vehicle/chattel information
year:
make:
model:
color:
VIN #:
license plate:
expiration:
key code:
loan balance:
monthly payment:
months past due:
amount past due:

delivery/storage instructions

how/where to be delivered/stored:

other info/comments

authorization 
authorized by: 
date: