Assignment Request | Tennessee Auto Recovery

AUTHORIZATION & HOLD HARMLESS
Tennessee Auto Recovery
Services Available Nationwide, specializing in the Tennessee and Southern Kentucky

Corporate Headquarters
5776 East Division Street Mt. Juliet, Tennessee 37122
Phone : 1.800.251.3355 or 1.615.470.8023
Fax : 1.615.470.8027

A. Legal Owner Information:

Legal Owner:

Referred By:

Adress:

City:

State:

Zip:

Phone:

Fax:

WATS:

Collector:

Email:

B. Debtor Information:

Debtor:

Phone

DOB:

Soc. Sec. #:

Address:

City:

State:

Zip:

Place of employment:

Address:

Phone:

City:

State:

Zip:

C. Comaker Information

Comaker

Phone

DOB

Soc. Sec. #:

Address

City

State

Zip

Place of employment:

Phone:

Address:

City:

State:

Zip:

D. Collateral Information:

Year:

Make:

Model:

VIN:

Color:

Plate:

State:

Key Codes:

Loan #:

Loan Balance:

Due Date:

Mo. Pymt:

Assigment Type:

Instructions:

This is your authorization 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:

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