Assign Recovery


  1. Client Information


  2. Client Name*
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  3. Collector*
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  4. Address & City*
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  5. State*
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  6. Zip Code*
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  7. Phone*
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  8. Fax
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  9. Email*
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  10.  


  1. Loan Information


  2. Type of Collateral
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  3. Date of Loan*
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  4. Balance of Loan*
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  5. Amount Overdue*
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  6. Date Last Paid*
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  7. Payment Amount*
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  8. Account Number*
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  9.  


  1. Collateral Information


  2. Year*
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  3. Make*
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  4. Model*
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  5. Color*
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  6. License Plate*
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  7. Complete Vin #*
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  8. Key Code*
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  9. Type of Account*
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  10.  


  1. Primary Debtor Information


  2. First Name*
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  3. Last Name*
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  4. SSN*
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  5. DOB*
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  6. DL #*
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  7. PhoneNumber*
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  8. Cell Number
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  9. Home Address*
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  10. City*
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  11. Zip*
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  12. Employer
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  13. Employer's Phone
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  14. Employer's Address
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  15. Employer's City
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  16. State
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  17. Zip
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  18. Please FAX References: 210-645-6110



  19. Secondary Debtor Information


  20. First Name
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  21. Last Name
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  22. SSN
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  23. DOB
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  24. DL #
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  25. PhoneNumber
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  26. Cell Number
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  27. Home Address
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  28. City
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  29. Zip
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  30. Employer
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  31. Employer's Phone
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  32. Employer's Address
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  33. Employer's City
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  34. State
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  35. Zip
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  36. Please FAX References: 210-645-6110

  37.  
  1. If there is any additional information you would like to provide please enter it here:
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  2. Authorize and Hold Harmless Agreement

    We agree to indemnify and hold Midnight Recovery of San Antonio harmless from and against any and all claims, damages, lossess and actions resulting from or arising out of the Midnight Recovery efforts to collect the above claim, except, however, such as may be caused by or arise out of negligence or unauthrized acts by Midnight Recovery, its employees or agents. Nothing contained herein shall be construed to authorize the violation of the laws of Texas. I am assigning this collateral for collection to Midnight Recovery. I am duly authorized by my company to make such an assignment. By typing my name in the box below and pressing the submit button below, I am digitally signing this authorization.

  3. I fully agree and understand the above statement*
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  4. Authorizing Signature*
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Contact Us

Cell phone
210-380-9725

Fax
210-239-5639

Call Us