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Assignment Form
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If you do not wish to use the online Assignment Form, please click the button below to use the PDF version of the form.
This form cannot be saved, however you can print and fax or email us.
Fax:
213-310-8201
Email:
assignments@driveparamount.com
ASSIGNMENT FORM PDF
Assignment Type:
Involuntary
Voluntary
Field Visit
Impound Repossession
Condition Report & Pictures
Bank / Finance Company / Forwarding Company:
Name:
*
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip:
Phone:
*
ex. (123) 456-7890
Fax:
ex. (123) 456-7890
Collector:
Email:
Loan Number:
Lien Holder:
Check this box if the info is the same as Previous Section
Legal Owner (Financier):
Referred By:
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip:
Phone:
ex. (123) 456-7890
Collector:
Email:
Collateral Information:
Make:
Model:
Year:
VIN or Serial Number:
Color:
Ignition Key Code:
Trunk Key Code:
License Number:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Debtor Infomation
Debtor:
Debtor Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip:
Phone
ex. (345) 567-2345
Social Security Number:
ex. 123-45-6789
Date of Birthday:
ex. 05/05/2007
Debtor Employment Information
Name:
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip:
Phone
ex. (123) 456-7890
Co-Signer Information:
Name:
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip:
Phone:
ex. (345) 345-5678
Social Security Number:
ex. 444-44-4444
Date of Birthday:
ex. 05/05/2007
Co-Sign Employment Information:
Name:
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Phone:
ex. (345) 345-5678
Loan Information:
Due Date:
ex. 05/05/07
Past Due Amount:
Monthly Payment:
Date Last Paid:
ex. 05/05/07
Loan Balance:
Special Instructions:
Your Authorization Authority
Consent
*
I understand
THE UNDERSIGNED (THE “CLIENT”) HEREBY REPRESENTS AND WARRANTS THAT CLIENT HAS A VALID INTEREST IN THE COLLATERAL DESCRIBED BELOW AND HAS A LEGAL RIGHT TO IMMEDIATE POSSESSION OF SAID COLLATERAL. THEREFORE, CLIENT AUTHORIZE PARAMOUNT RECOVERY SERVICES ITS EMPLOYEES AND AGENTS (COLLECTIVELY, “PRS”) TO REPOSSESS THE COLLATERAL DESCRIBED BELOW. FURTHERMORE, CLIENT AGREES TO INDEMNIFY PRS AND HOLD PRS HARMLESS FROM ANY AND ALL LIABILITY ARISING OUT OF THE REPOSSESSION RESULTING FROM ANY NEGLIGENCE, ERROR OR OMISSION BY THE CLIENT, INCLUDING ANY ERRORS REGARDING CLIENT’S RIGHT TO POSSESSION OF SUCH COLLATERAL. IT IS UNDERSTOOD THAT PRS WILL ACT AS AN INDEPENDENT CONTRACTOR WHILE MAKING SUCH REPOSSESSION AND THAT CLIENT HAS NO RIGHT TO CONTROL AND DIRECT THE MANNER IN WHICH PRS PERFORMS SUCH SERVICES. THE TIME, MANNER AND METHOD OF PERFORMANCE OF SUCH SERVICES SHALL BE DETERMINED BY PRS IN ITS SOLE DISCRETION. CLIENT AGREES TO IMMEDIATELY NOTIFY PRS OF ANY SETTLEMENTS MADE BY CLIENT SO THAT PRS CAN CEASE ITS REPOSSESSION EFFORTS. UNLESS OTHERWISE AGREED TO OR SPECIFIED, CLIENT AGREES TO PAY PRS’S STANDARD RATES, FEES AND EXPENSES OR SUCH FEES AND EXPENSES SPECIFIED AND AGREED TO BY CLIENT AND PRS. TO THE EXTENT ANY LEGAL DISPUTES ARISE OUT OF THIS ASSIGNMENT, BY SIGNING BELOW, CLIENT AGREES THAT SUCH DISPUTES SHALL BE GOVERNED BY THE LAWS OF THE STATE OF CALIFORNIA AND ALL SUCH ACTIONS MAY ONLY BE BROUGHT AND ADJUDICATED IN THE STATE OF CALIFORNIA.
Authorized By:
*
Date:
*
ex. 05/05/07
81565