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Dixon Recovery Assignment Form

Repossession Order



Leinholder Address

Leinholder Phone with Extension

Leinholder Contact Person

Debtor Name

Debtor Address

Debtor Phone Number

Debtor SocialSecurity Number

Debtor Date of Birth

Debtor Employer

Employer Phone Number

Employer Address

Comaker Name

Comaker Address

Comaker Phone Number

Comaker SocialSecurity Number

Comaker Date of Birth

Comaker Employer

Comaker Employer Phone Number

Comaker Employer Address

Additional Information:





Vin Number

Tag Number

Amount Past Due

Monthly Payments

Loan Balance

Past Due Date

Contract Date

We, the above named client, agree to indemnify and hold you harmless from and against any and all claims, damages, losses and actions resulting and arising out of repossession of, or your effort to repossess this unit, except such as may be caused by or arise out of negligence or unauthorized illegal acts. We understand that Dixon Recovery, LLC does not accept assignments on a contingency basis.

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