Back Home

Assignment Form

Dixon Recovery Assignment Form
Repossession Order
Leinholder Address
Leinholder Phone with Extension
Leinholder Contact Person
Debtor Name
Debtor Address
Debtor Phone Number
Debtor Social Security Number
Debtor Date of Birth
Debtor Employer
Employer Phone Number
Employer Address
Comaker Name
Comaker Address
Comaker Phone Number
Comaker Social Security 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.