Submit Repossession Assignment
Repossession Assignments are accepted 24 hours a day.

If you should require any assistance with filling out this form please dont hestitate to contact us at the numbers to the right. If you require to submit us a short message, please use this form. As always we thank you for choosing Premier Finance Adjusters for your collateral repossession needs.


* Indicates a required field.

Authorization and Hold Harmless
*

BORROWER INFO:

Debtor:
First Name: Last Name:
Street: Apt/Suite:
City: State: Zip:
Home Phone: Cell Phone:

Employment: Phone:
POE Address:
POE City: State: Zip

Co-Debtors Address:
First Name: Last Name:
Street: Apt/Suite:
City: State: Zip:
Home Phone: Cell Phone:

Employment: Phone:
Address:
POE City: State: Zip:

COLLATERAL INFO:
*Year: *Make: *Model:
Color: License Plate: State:
*VIN:
Please note that if the unit is a 4x4 (Four Wheel Drive) or an AWD (All Wheel Drive) we request a pre approved $125.00 flat bed fee as traditional tow methods would damage the unit. This fee is applied to the final repo costs.
If the unit is one of these please check the following box. Thank you.
4x4 / AWD

ACCOUNT INFO
*Account Number: Days Past Due:
Unpaid Balance: Amount Past Due:
Payment Amount: Next Payment Due:
Addtional Info:


CLIENT INFORMATION & AGREEMENT
 
*Company Name:
*Email:
*Contact Name: *Phone: Ext:
*Billing Address:
 

*This is your, Premier Finance Adjusters, authorization to act as our agent to collect and/or repossess on sight, the above collateral which is covered by contract. You are not to reassign if no longer in your service area, unless approved. Report any findings and send detailed condition report with invoice. We agree to indemnify you and save you harmless from and against any and all claims including court costs, reasonable attorney fees, and other expense of litigation, except for unauthorized acts of your firm. This indemnification is granted as consdered 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, acknowledge and keep us fully informed.
* By checking this box, you fully agree to the above. (You must check this to submit assignment.)

We thank you for your business!

Contact Details
Feel free to contact via the info provided below or fill out the form to the left and someone will be in touch with you shortly.

Address: 5875 Washington Ave, Export, PA
Telephone: (724) 498-4274
FAX: (724) 498-0919
Toll Free:: (800) 882-3092


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