TO PLACE A REPOSSESSION ORDER
To insure proper repossession service, please furnish the agency with the following information.
Debtor’s Full Name____________________________________________ Phone #_______________________
Address______________________________________City_________________State________ZIP______________
Date of Birth______________________________________SSN_________________________________________________
Driver’s License # (including Date)____________________________________________________________________
Present Employment (including Address & Phone #)_____________________________________________________
Last Known Employer (including Address & Phone #)____________________________________________________
Marital Status_______________________________ Spouse’s Full Name_______________________________________
Spouse’s Employment (including Address & Phone #)_____________________________________________________
Debtor’s Relatives (including Address & Phone #)_________________________________________________________
Spouse’s Relatives (including Address & Phone #)________________________________________________________
Credit References (including Address & Phone #)________________________________________________________
Key Codes ( if Known) IGN. CODE_____________________________DOOR CODE_______________________________
Name & Address of Selling Dealer______________________________________________________________________
Dealer Phone # _________________________________________Sales Persons Name____________________________
Any Special Equipment ( snow plow ...ect.)_______________________________________________________________
Original Contract Date_________________ Original Amount of Contract_____________________
Original Schedule of Payments_______________________________________________$_________________________
Total Amount Past Due_______________________________________ Late Charges Due_________________________
Month & Date of Delinquency____________________________ Date of Last Payment____________________________
Account Number______________________________________________________________________________________
Lien Holder:_________________________________________________
Contact Person: _____________________________________________
Address: _____________________________________________________
City: ________________________ State:________ Zip Code:____________
Phone # _______________________ Ext. # :____________ Fax # __________________________
To: Buffalo Auto Recovery Service / 76 Roberts Ave / Buffalo, NY 14206
Phone # 716-827-1116 Fax # 716-827-1035 Cellular # 716-570-2172
We currently have a delinquent account # _______________________________________________
in the name of :________________________________whom we know resides
at:________________________________________________________________________
As collateral for this loan, we have obtained a security interest in a vehicle identified as follows:
Year: _____________ Make: ______________________ Model:___________________
Body Type:_______________________ Plate #___________________ Color:__________
VIN: _______________________________________________
We wish to engage (you) (your firm) to repossess said vehicle and agree to indemnify you for all reasonable costs and expenses incurred in connection with the repossession, including any costs and expenses involved in defending any lawsuit which may be brought against you.
Notwithstanding the above, this request to engage your services should not be deemed to constitute you as an agent of this company, nor as an agreement to indemnify (you) (your firm) for any costs, fees, or damages which you may incur based upon any events which may arise out of, through or by reason of you or your agent's negligence, or any unauthorized or illegal acts, performed or committed by you or any of your agent.
Signature _________________________________