Afficient Towing and Recovery

Submit an Assignment
Afficient Recovery
Services Available throughout all of Arizona

Corporate Headquarters
P.O.Box 37962
Phoenix, Arizona 85069
Nationwide Assignment Center
Phone : 1.623.931.6697 (Within Arizona)
or 1.800.848.1785 (From Any Other State)
Fax : 1.623.931.6796

AS LEGAL OWNER AND/OR LIEN HOLDER of the chattel hereon described, the below named lien holder hereby declares that the borrower's contract of sale or security agreement covering said chattel is in default. Therefore, I (or we) do hereby authorize the agency whose name is printed below, or their agents to act as my or our agent or to make demand for or to repossess without demand, said chattel, and/or taking such other action as he or they may deem necessary.

Our Account #:

You Account Number:

Date Recieved:

Borrower:

Spouse:

Age:

Previous Address:

Employer:

Dependants:

Relatives:

Friends:

Agent:

Trade Ref.:

Agents Chgs:

Late Chgs:

Del Int:

Dip:

Del Payments: $

Lien Holder:

Amt Payments: $

Contract Balance: $

Ignition Key:

Trunk Key:

License Number:

State:

ID#:

Color:

Chattel:

Instructions:

Order of Repossession

Date:

Legal Owner or Lein Holder:

Registered Owner or Borrower

Description of Chattel

Model Year:

Trade Name:

Body Style:

I.D. Number:

License Number:

Contract Balance:

Delinquency:

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.

Authorized by:

Date: