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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)
Involuntary Repo
Voluntary Repo
Collection Only
Door Knock
Transport
GPS
Yes
No
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
Submit
