This is your authorization to act as our agent to collect or repossess the above collateral.  We agree to indemnify and hold you harmless from and against any and all claims, damages, losses and actions including reasonable attorney fees, resulting from and arising out of your efforts to collect and or repossess, except, however, as such may be caused by or arise out of negligence or unauthorized acts on the part of you, your company, its officers, employees or its agents.

Phone: (866) 458-7376 (REPO)

Fax: (850) 456-3390

E-mail: whitesandsrecsys@cox.net

To contact us:

Assignment Form

Please Fill Out this entire form and then click “Submit”

White Sands Recovery Systems, Inc.  Assignment Form

Lien holder:

Address:

City:

State:

Zip:

Collector:

E-Mail:

Phone:

Ext:

Fax:

Debtor:

Address:

City:

State:

Zip:

E-Mail:

Phone:

DOB:

SS#:

Lien Holder Information

Debtor Information

Debtor Employment

Debtor Employer:

Address:

City:

State:

Zip:

Phone:

Ext:

Co-Debtor:

Address:

City:

State:

Zip:

E-Mail:

Phone:

DOB:

SS#:

Co-Debtor Information

Co-Debtor Employment

CO-Debtor POE:

Address:

City:

State:

Zip:

Phone:

Ext #:

Collateral Description

Vehicle Description:

VIN #:

Tag #:

State:

Color:

Key Codes:

Contract Information

Account #:

Past Due Date:

Monthly Payment: