Submit an Assignment

Hall Recovery Specialists DFW

1315 N. Cockrell Hill Rd., Duncanville, TX 75116

Dallas

  • Phone: 800-336-4176, or 972-298-3338
  • Fax: 972-298-3584

Fort Worth

  • Phone: 800-872-1611, or 817-534-0724
  • Fax: 817-429-5777

REPOSSESSION ASSIGNMENT FORM / ORDER OF SEIZURE

[ .= Required. Caution: Those fields preceded by this symbol are "required" fields. Failure to fill out those fields will result in failure to transmit this form. You would receive a "failure to correctly fill out the form" message, indicating which required fields were left blank, and the form will then reset to all blank fields. These " ." fields are required.]

Filling out all fields preceded with an " ."will result in a successful transmission of this form, and you will receive a confirmation on screen which may be printed out for your records if you wish. Any additional fields that you can fill in will be greatly appreciated. Thank you.

REPOSSESSION / ORDER OF SEIZURE FORM

.Client: Order Date:

.Address: Assigned By:

.City: .State: .Zip:

.Phone:Watts Number:

.Legal Owner: Fax:

.E-mail:

DEBTOR INFORMATION

.Last Name:.First Name:Middle Name:

D.O.B./Age: SS #:

Address:

City: State: Zip:Phone:

Previous Address:

Employer: Work Phone:

Address:

Previous Employment: Driv.Lic. No.:

Spouse's Name:

Spouse's D.O.B./Age: Spouse's Social Sec.No:

Spouse's Employer:

CO-MAKER INFORMATION [If Applicable]

Last Name: First Name:

D.O.B./Age: Social Sec.No:

Address:

City: State: Zip:Phone:

Employment/Other Info.:

VEHICLE INFORMATION

.Year .Make .Model Color

.VIN Number

DealerIgnition Key Number:

Trunk Key Number: Plate:State:

LOAN INFORMATION

Date of Loan: Original Loan Account Number:

Monthly Payments:$ :Delinquent:Months (Please Provide)

Amount Past Due:$: Balance:$: Past Due Date:

Monthly Payment Due:$Date of Last Payment

Amt. of Last Payment:$ Applied to Which Month?

REFERENCES/REMARKS: If you have information on the debtors family members, relatives of the debtor, or any other information that would be helpful to us at Hall Recovery Specialists in the recovery of your vehicle, please enter that information in the "Instructions" space below. Thankyou.

This is authorization to act as our agent to collect or repossess the above collateral. We agree to indemnify and hold Hall Recovery Specialists, DFW 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. Submission of this form via the internet, forwarded through the web site of Hall Recovery Specialists DFW, located at www.hallrecovery.com shall constitute full authorization to consider this as a work order.

.Authorized by:.Date:

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