Tri State Auto Recovery Inc. - Cincinnati OH
4381 Mayhew Avenue     Cincinnati, Ohio  45238     Phone: 513-471-1310   Fax: 513-251-7433

Repossession Form

Please provide the following information to submit a repossession. You will automatically receive a response from us to let you know that we have received your request. Thank you for your business. We appreciate your patronage.

Your Company Information
* = Required Field
* Company:
* Billing Address:
Address 2:
* City:
* State:
* Zip:
* Phone:
Alternate Phone:
Fax:
* Assignment Type:
   
   

Debtor Information
  * = Required Field
* Debtor:
* Address:
* City:
* State:
* Zip:
* Home Phone:
SS#:
DOB:
   
   

Debtor POE Information
POE:
Address:
City:
State:
Zip:
Phone:
Shift:
Employment Verified?:
   
   

Vehicle Information
  * = Required Field
* Year:
* Make:
* Model:
* VIN:
Color:
Plate:
State:
Key Code:
Type of Vehicle:
   
   

Loan Information
Date of Loan:
Payment Amount $:
Delinquent Amount:
Balance:
Past Due Date:
   
   

Co-Maker Information
Co-Maker:
Address:
City:
State:
Zip:
Home Phone:
SS#:
   
   

Co-Maker POE Information
POE:
Address:
City:
State:
Zip:
Phone:
   
   

Additional Information/References

If you have information on the debtor's family members, relatives of the debtor, or any other information that would be helpful to us in the recovery of your vehicle, please enter that information in the space below:
   
   

Hold Harmless

This is your authorization to act as our agent to collect or repossess on site all collateral which we assign to you which is covered by a defaulted contract. You are not to reassign if no longer in your service area without our prior written approval. We agree to indemnify and hold Tri State Auto Recovery Inc. harmless from and against any and all claims, including but not limited to court costs, reasonable attorney fees and other expenses of litigation including those arising from damage done to the collateral, except for unauthorized acts of your firm. This indemnification is granted as consideration for your acting as our agent. It is agreed that this contract is executed within your state and that the laws of your state shall be applicable. When there are two states involved, the laws of both states may be applicable.

I am assigning this claim for collection to Tri State Auto Recovery Inc. I am duly authorized by my company to make such an assignment. By typing my name in the box below and pressing the submit button, I am digitally signing this authorization.

Form Authorization
  * = Required Field
*Authorized First Name:
*Authorized Last Name:
*Authorized Email:
*Date:


 

The unauthorized use, disclosure, copying or alteration of this form is strictly forbidden.

  |   Home

Valid HTML 4.01!

All materials including text and graphics are copyrighted and are the property of the Webmaster.
© All rights reserved.