Assignment


	National Recovery Network

		Repossession Order

** Only persons authorized by a respective principal may submit the following Repossession Order to National Recovery Network

PLEASE NOTE: All fields are mandatory.


Lien Holder Name :

		Address :

	City, State, Zip :

			Phone :

					Fax :

				Email :


		Lien Holder Information

			(Finance Company)

	(ie. Denver, Colorado 80424)

	(in the format: (###) ###-####)

(in the format: (###) ###-####)


Reg Owner Name :

		Address :

	City, State, Zip :

			Phone :

					Fax :

				Email :


	Private Party Information

		(Private Party Repossessions Only)

(ie. Denver, Colorado 80424)

(in the format: (###) ###-####)

(in the format: (###) ###-####)


					Debtor Name :

							Address :

						Date of Birth :

								SSN # :

Last Known Address :

		City, State, Zip :

	Last Known Phone :

				Spouse Name :

						Date of Birth :

			Spouse SSN# :


	Debtor Information

		(Person in Possession of Property)

(in the format: ### - ## - ####)

(ie. Denver, Colorado 80424)

(in the format: ### - ## - ####)


Last Known Employer :

		Occupation :

			Address :

	City, State, Zip :

				Phone :


		Debtor Employment Information

	(ie. Denver, Colorado 80424)

	(in the format: (###) ###-####)


							Year :

				Make :

			Model :

					Color :

						VIN# :

	State Plate Issued :

		Plate Number :

Collateral Description :


		Collateral Information

	(Please give thorough description of the collateral to be recovered)


			Balance Owed :

		Monthly Payment :

				Amount Due :

	Months Past Due :

Additional Comments :


	Loan Information


	AGREEMENT:

As evidenced by a security agreement which is currently in default, we hereby certify that we have the
right to the immediate possession of the collateral described above. In accordance with local laws, we hereby authorize National Recovery Network to proceed on our behalf, without judicial process, to take possession of the collateral above described and deliver same to their storage facility.

We agree to indemnify, save and hold harmless National Recovery Network, its principals, employees and agents from any and all claims, damages, losses and actions resulting from or arising out of efforts to collect and/or repossess the above claim, except, as may be cause by or arise out of negligence on the part of your agency, its principals, employees or agents.


	Signature :


	Date :