Authorization to Repossess

Lender:

Lender Contact Name:

Lender Contact Number:

Lender Email Address:

Address:

City/ST/Zip:

Assignment Date:

Lender Signature

This is your authorization to act as our agent to collect or repossess the collateral listed below. We name Alternative Collections, LLC dba ACS (Asset Compliant Solutions) as our exclusive agents for repossessing the collateral listed below. We have reviewed and agree to the pricing schedule and payment terms provided by ACS. We agree to indemnify and hold you harmless from and against any and all claims, damages, losses and actions including reasonable attorney fees, except for any unlawful acts by your company. You will not be held liable for the mechanical operation of the collateral or for insurance protection except in case of neglect.

Placement Type (select one):

GPS

Borrower Name:

Guarantor Name:

Main Address

City:

State:

Zip:

Home Phone:

Cell Phone:

Other Phone:

Special Instructions

Account Number

Year/Make/Model:

SN/Vin#:

Account Number

Year/Make/Model:

SN/Vin#:

Account Number

Year/Make/Model:

SN/Vin#:

Account Number

Year/Make/Model:

SN/Vin#:

Attachments/Implements:

Days Past Due:

Past Due Balance:

Payment Amount:

Due Date:

Comments:

Delivery Location:

Main Phone:

Address:

City:

State:

Zip:

Contact Person:

Email Address:

Authorization to Repossess

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