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Golden State Recovery Online Assignment Form

P.O.Box 534

Fast Efficient Service
Santa Maria, CA 93456

Specializing in ALL of California

Ph. (800) 248-4893

Fax (805) 922-8611
To send an assignment please fill out the following form. Please be as thorough as possible. Remember the more information that you give us the faster we will secure your collateral. If you need to send addition information (IE. Credit apps, social searches, or any other information). Please fax to 805.922.8611. We have 24 hour service and this is a 24-hour assignment center. All accounts received will be worked as soon as received unless otherwise noted.
A/C No: ASSIGNMENT OF CLAIM: Unless otherwise agreed a secured party has on default the right to take possession of the collateral. In taking possession a secured party may proceed without judicial process if this can be done without breach of the peace or may proceed by action. If the security agreement so provides the secured party may require the debtor to assemble the collateral and make it available to the secured party at a place to be designated by the secured party which is reasonably convenient to both parties. Without removal a secured party may render equipment unusable, and may dispose of collateral on the debtor's premises.
Legal Owner:
Attn:
Address:
City:
Telephone No.:
Debtor: LOAN NO.:
Debtor Address: Key Code-IGN:
Your Email: Key Code-TR:
Additional Information:
Year Model: Body Style:
Make: Motor Number:
Color: License Number:
State: Year:
Identifying Data:
Debtor SS#: Debtor D.O.B.:
Balance Due: Amount of Payments:
Past Due: .
Clients Instructions:

DISCLAIMER: This is your authorization to act as our agent to collect or repossess the above collateral. We agree to indemnify and hold you 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. I have read and understand all the terms and agreement of the service contract.

Authorized by: Date:

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