Reid and Reid Recovery

DFW's #1 Collateral Recovery Company
Assignment Form
Assignment Form

Please conplete the following form for all assignments. Form will be sent directly to a representative at Reid and Reid Recovery.

Client Name:
Address:
City, State, Zip:
Phone:
Email:
Fax:
Debtor Name:
Address:
City, State, Zip:
Date of Birth:
SSN#:
Spouse Name:
Any other information that may be of assistance:
Debtor Last known Employer:
Occupation:
Employer Address:
Lien Holder:
Lien Holder Information:
Lienholder Address:
Year:
Make & Model:
Color:
VIN #:
Plate #:
State Plate Issued:
Current Balance Owed::
Current Value of Property:
Monthly Payment:
Months Past Due:
Amount Last Paid:
Date Last Paid:
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Who did you speak with at Reid and Reid Recovery:
Agreement:

I, here-in-after referred to as “Client,” agree that I am entering into a contract with Reid and Reid Recovery. I further
acknowledge my electronic signature will serve as your authorization to act on my behalf in repossessing and impounding the
above-described collateral which is covered by a defaulted installment contract, lease agreement or verbal agreement. I agree
that by typing my name in the “Electronic Signature” along with my personal identifying information contained in the
electronic form submitted with these agreed upon terms, I am utilizing my typed name as my electronic signature for
purposes of entering this contract, and I intend my electronic signature to be legally binding. I further agree that by
submitting this form, I affirm my legal entitlement to possession of the above described collateral. Through submission of
this form and its accompanying Electronic Signature, Client appoints Reid and Reid Recovery exclusive agents for
repossessing the above-described collateral. I understand that this means any agent Client previously engaged is no longer
authorized to repossess this vehicle unless they are subsequently authorized to do so by Reid and Reid Recovery.

  I agree with general terms and conditions
Signature:
Date:
 
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