Concho Auto Recovery

*Lienholder:
Address:
City:
State:	Zip:
Phone:	Extension:
Fax:
E-mail:
Collector:

Debtor:
Address:
City:
State:	Zip:
Phone:
Fax:
E-mail:
SSN and Date of Birth:

Debtor's POE:
Address:
City:
State:	Zip:
Phone:	Extension:

Co-Maker:
Address:
City:
State:	Zip:
Phone:
Fax:
E-mail:
SSN and Date of Birth:

Co-Maker's POE:
Address:
City:
State:	Zip:
Phone:	Extension:

Collateral Year, Make & Model:
Plate, State & Color:
Key Numbers:
Vehicle Identification Number:

Loan #:
Past Due Date:
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.

This is your authorization to process for collection, location, or repossession of the above described assignment. We agree to indemnify and save you harmless from and against any claims, damage, losses, and action resulting from or arising out of your efforts to collect, locate or repossess the above claim, except, however such as may because or arises out of negligence or unauthorized acts of your company, its officers, employees, or the officers or employees of such agents.

Authorized by:
Date:
*All fields marked with an asterisk are required

Concho Auto Recovery
P.O. Box 5390
San Angelo, TX 76902
1169 Fairview School Rd.
San Angelo, TX 76904
Phone: (325) 949-2874 or Fax: (325) 947-2422

Any Questions? Please feel free to contact us at (325) 949-2874, or via FAX at (325) 947-2422.

Concho Auto Recovery P.O. Box 5390 San Angelo, TX 76902 1169 Fairview School Rd. San Angelo, TX 76904 Phone: (325) 949-2874 or Fax: (325) 947-2422

Any Questions? Please feel free to contact us at (325) 949-2874, or via FAX at (325) 947-2422.

Concho Auto Recovery
P.O. Box 5390
San Angelo, TX 76902
1169 Fairview School Rd.
San Angelo, TX 76904
Phone: (325) 949-2874 or Fax: (325) 947-2422