This Repossession Request can also be printed and faxed to us in the "Downloads" section.

YOUR COMPANY *
AUTHORIZED BY *
MAILING ADDRESS *
PHONE *
FAX *
EMAIL *
DEBTOR FIRST NAME *
DEBTOR LAST NAME *
DATE OF BIRTH
LAST KNOWN ADDRESS *
TELEPHONE
WORK PHONE
NAME OF EMPLOYER
EMPLOYMENT ADDRESS
IS THERE A CO-SIGNOR *	Yes No
CO-SIGNOR FIRST NAME
CO-SIGNOR LAST NAME
CO-SIGNOR DATE OF BIRTH
CO-SIGNOR ADDRESS
CO-SIGNOR PHONE
CO-SIGNOR EMPLOYER
EMPLOYER ADDRESS
EMPLOYER PHONE
VEHICLE YEAR
VEHICLE MAKE
VEHICLE MODEL
FULL SERIAL NUMBER
PLATE NUMBER
VEHICLE COLOR
MVS SEARCH AUTHORIZATION *	Yes No
LIEN HOLDER *
YOUR FILE NUMBER
ARREARS TO DATE *
NEXT PAYMENT DUE *
PAYMENTS ARE MONTHLY	Yes No
PAYMENTS ARE BI-WEEKLY	Yes No
PAYMENT AMOUNT
OUTSTANDING LOAN BALANCE
CSA	Yes No
CHATTEL MORTGAGE	Yes No
LEASED	Yes No
GARAGE LIEN	Yes No
PRIVATE SALE	Yes No
YOU HAVE READ THE INDEMNITY CLAUSE *	Yes No
YOU INDEMNIFY US TO PROCEED *	Yes No