Grim Repo Assignment Form

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ASSIGNMENT FORM

**Please note that all assignments sent to Grim Repo are subject to verification. If you are a new client we suggest contacting us by phone prior to sending an assignment to find out about our rates and policies.

Please fill out the online assignment form below and hit the submit button at the end of this page. We will start working on the assignment right away and we will get back to you shortly. All fields with (*) must be filled with the correct answer before submitting this assignment form. Thank you.

Please enter as much information as possible in the form below. The more complete your information and descriptions, the better.


LEGAL CREDITOR INFORMATION

*Company Assigning :

Account # :		Lienholder :

*First Name :

	Initial :	*Last Name :

*Address :

*City :

	*State :	*ZIP :

*Phone # :

	Ext. :

Fax # :

*E-mail :

COLLATERAL PROPERTY INFORMATION

*Make :

	*Model :	Color :

*VIN # :

	Year :

License # :

	State :

Key Code :

DEBTOR INFORMATION

*First Name :

	Initial :	*Last Name :

Soc. Sec :

	Date of Birth :

Phone # :

	Cell Phone # :

Address :

City :

	State :	ZIP :

Employer :

	Phone # :	Ext. :

Address :

City :

	State :	ZIP :

CO - DEBTOR INFORMATION

First Name :

	Initial :	Last Name :

Soc. Sec :

	Date of Birth :

Phone # :

	Cell Phone # :

Address :

City :

	State :	ZIP :

Employer :

	Phone # :	Ext. :

Address :

City :

	State :	ZIP :

LOAN INFORMATION

Loan # :

		Loan Balance :

	Payment Amount :

Date Due :

	Date Last Paid :

NOTE: The more information or background regarding family members and relatives of the debtor that you can give us on the this account will help us to locate the collateral much quicker. Please enter that information in the "Comments" space below.

Comments
or
Alternate Addresses:

Delivery Instructions:

	Assignment Type :

AUTHORIZATION INFORMATION

YOU ARE AUTHORIZED TO REPOSSESS THE AUTOMOBILE DESCRIBED ABOVE. IT IS UNDERSTOOD THAT YOU WILL ACT AS AN INDEPENDENT CONTRACTOR WHILE MAKING SUCH REPOSSESSION, AND WE RESERVE NO RIGHT TO CONTROL AND DIRECT THE MANNER IN WHICH YOU PERFORM THE SERVICES FOR US. THE TIME, MANNER AND METHOD OF PERFORMANCE OF SUCH SERVICES SHALL BE DETERMINED BY YOU, YOU ARE ACCOUNTABLE TO US FOR THE ULTIMATE RESULTS ACCOMPLISHED THROUGH THE RENDITION OF SUCH SERVICES. WE WILL PAY YOUR USUAL RATE, FEES AND EXPENSES FOR THE SERVICES PERFORMED IN THIS CONNECTION, AND WILL NOTIFY YOU IMMEDIATELY OF SETTLEMENTS MADE BY US SO THAT REPOSSESSIONS SHOULD NOT BE CARRIED OUT. WE AGREE TO PROTECT AND HOLD YOU HARMLESS FROM ANY AND ALL LIABILITY OF EVERY KIND AND NATURE IMPOSED OR SOUGHT TO BE IMPOSED UPON YOU AS A RESULT OF ANY NEGLIGENCE, ERROR, OR OMISSION ON OUR PART INCLUDING EMPLOYEES AND/OR AGENTS. WE HEREBY WARRANT THAT WE ARE ENTITLED TO IMMEDIATE POSSESSION OF THE VEHICLE DESCRIBED.

	*I have read and understand the above agreement.

*Authorized By :

*Title :	*Authorized Date :

**Please note that all assignments sent to Grim Repo are subject to verification. If you are a new client we suggest contacting us by phone prior to sending an assignment to find out about our rates and policies.