Submit your assignment online here using the below form, or click the RDN logo to login:
Lienholder:
Address:
City:
State:
Zip:
Phone:
Extension:
Fax:
E-mail:
Collector:
Debtor:
Address:
City:
State:
Zip:
Phone:
Fax:
E-mail:
SSN and Date of Birth:
Employment:
Address:
City:
State:
Zip:
Phone:
Extension:
Collateral Year, Make & Model:
Plate, State & Color:
Key Numbers:
Vehicle Identification Number:
Loan #:
Past Due Date:
Monthly Payment:
Loan Balance:
Assignment Type:
Note: Should you have any information regarding family members, relatives of the debtor, or any unique or defining information
that would be helpful in aiding us in the recovery of your vehicle, please
enter that information in the "Instructions" space below.
This is authorization for Recovery America to act as our agent to collect or repossess the above collateral. We agree
to indemnify and hold you harmless from and against any and all claims,
damages, losses and actions including reasonable attorney fees, resulting
from and arising out of your efforts to collect and or repossess claims,
except, however, as such may be caused by or arise out of negligence or
unauthorized acts on the part of you, your company, its officers, employees
or its agents.
Authorized by:
Date:
Please type in the box the numbers and/or letters you see. If you are having trouble viewing this image click to generate another.
