Georgia Recovery Services On-Line Assignment Form

Georgia Recovery Services, Inc. Assignment Center

Corporate Headquarters
254 Freeland Rd
Dawsonville, GA 30534
Phone: 706.216.5455 | Fax: 706.216.5555

Lienholder:

Address:

City: State: Zip:

Phone: Extension: Fax:

E-mail:

Collector:

Debtor:

Address:

City: State: Zip:

Phone: Extension: Fax:

E-mail:

Social Security Number and Date of Birth:

Employment:

Address:

City: State: Zip:

Phone: Extension: Fax:

Collateral Year:MakeModel

Color:

Key Code:

Vehicle Identification Number:

Loan #:

Past Due Date: Past Due Amount:

Monthly Payment: Loan Balance:

Assignment Type:

Note: 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 "Instructions" space below.

Please provide information in this space:

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:

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Any Questions? Please feel free to contact us at 1.706.216.5455
Or you may contact us via E-mail at:

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