Involuntary / Voluntary Assignment | Faith Financial Group

ASSIGNMENT TYPE:*

Order Date:*

Account #:*

Client / Legal Owner:*

Address:

Street Address City State ZIP Code

Phone:*

Fax:

Email:

Assignee:*

Direct:*

DEBTOR:*

SS# :

DOB :

Address

Street Address City State ZIP Code

Home Phone:

Cell Phone:

WORK:

Address:

Street Address City State ZIP Code

Work Phone:

CO DEBTOR:

SS# :

DOB :

Address

Street Address City State ZIP Code

Home Phone:

Cell Phone:

WORK:

Address:

Street Address City State ZIP Code

Work Phone:

Additional Info:

Monthly Payment ($):

Last Payment ($):

Balance ($):

Vehicle Information

VIN:*

Year:*

Make:*

Model:*

Color:*

Tag/State:*

Key Code:*

This is your authorization to process for collection or repossession of the above described assignment. We agree to indemnify and save you harmless from and again any and all claims, damage, losses and action resulting from or arising out of our efforts to collect or repossess the above claim. Except, however such as may be cause or arises out of negligence or unauthorized acts of your company, it’s officers, employees, or the officer or employees or such agents.

Authorized By (Please Print):*

Authroized Signature:*

Date:*

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