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Houston Area Repossession Assignment Form..

Lienholder Contact Information:

Account #
Repo Type Voluntary  Involuntary
First Name
Last Name
Title
Firm
Address
 City-St-Zip 
Phone Ext
FAX
E-mail *

E-Mail:

Buyer Information:

First Name
Last Name
Middle Initial
SS#
ODL
Date of Birth
Sex Male Female
Address
 City-St-Zip 
Home Phone
Work Phone Ext
Employer
POE Address
 City-St-Zip 

Co-Buyer Information:

First Name
Last Name
Middle Initial
SS#
ODL
Date of Birth
Sex Male Female
Address
 City-St-Zip 
Home Phone
Work Phone Ext
POE Address
 City-St-Zip 

Vehicle Information:

Year
Make
Model
Color
VIN Number
License 
Expiration
Key Code
Balance

Payment

Past Due 

Date      Amt

Special Instructions
Should you have any information regarding family members, relatives of the debtor, or any unique or defining information that would be helpful in aiding us in the recovery of your vehicle, please enter that information in the space below as well.


 

By clicking on the 'Submit Form' button below, I authorize MLSI 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.

 



Metro Lenders Service Inc. repo office is located in Houston and our contact number is 713-939-REPO