Copy and paste this information into an email
or print the assignment and fax it:

Request for Repossession
*Required Information

Is the collateral being surrendered voluntarily?
Yes No
Client/Legal Information
*Submitted By:
*Company:
Address:
City:
State:
Zip:
*Contact Person:
*Contact Phone:
Contact Fax:
* Contact Email:
Customer Information
Account Number:
*Full Name:
*Phone:
Birthdate:
*SSN:
*Address:
*City:
*State:
*Zip:
Employer:
Employer Address:
Employer City:
Employer State:
Employer Zip:
Spouse Full Name:
Spouse Phone:
Spouse Birthdate
Spouse SSN:
Spouse Address:
Spouse City:
Spouse State:
Spouse Zip:
Collateral Information
Collateral Address:
(if different from Customer Address)
Collateral Type::
(Car, Truck, Aircraft, Boat, RV, Motorcycle, ATV,
Personal Watercraft, Heavy Equipment, etc.)
*Year:
*Make:
*Model:
License Plate:
State:
*VIN:
Comments:

In order for us to service this account,
you must fax or email the supporting documentation such as title
and Hold Harmless if not on file to:
1-530-246-0164
norcalrecovery@norcalrecovery.com