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Printable Assignment Form - PDF Format
Online Assignment form - Assigned to: Imperial Recovery Agency, 451 Chair Avenue, Lexington, KY 40508

INDEMNIFICATION AGREEMENT and REPOSSESSION ORDER

WE WOULD APPRECIATE YOUR REPOSSESSION ASSISTANCE ON THE IDENTIFIED CUSTOMER WHOSE ACCOUNT IS SUMMARIZED BELOW.

PLEASE DO NOT ASSIGN THIS ACCOUNT TO A COLLECTION AGENCY OR AN ATTORNEY FOR COLLECTION OR LEGAL ACTION OR ASSISTANCE UNLESS PRIOR APPROVED WRITTEN NOTICE IS GIVEN BY US.

WE AGREE TO INDEMNIFY YOU AND SAVE YOU HARMLESS FROM AND AGAINST ANY AND ALL CLAIMS, DAMAGES, LOSSES AND ACTION RESULTING FROM AND ARISING OUT OF YOUR EFFORTS TO COLLECT THIS ACCOUNT EXCEPT, HOWEVER SUCH AS MAYBE CAUSED BY OR ARISE OUT OF NEGLIGENCE OR UNAUTHORIZED ACTS OF YOUR AGENCY, ITS OFFICERS, EMPLOYEES, OR AGENTS. 

VOLUNTARY
INVOLUNTARY

Order Date
e.g."01/01/2002"
Debtors Account Number
Your Business Name
Phone No.
Ext.
Assigned by
Fax No.
Debtors Name
Co-Maker
Address
Suite/Apt.#
City
State
Zip
Home Phone
Business Phone
Debtors Employer
Co-Makers Employer
Debtors Social Security No.
Co-Makers Social Security No.
Debtors Date of Birth
Co-Makers Date of Birth
Collateral Location
Key Codes - License Plate
Year
Make
Model
VIN#
Color
Ignition
Trunk
Door
License
Number
State
Expiration Date
Balance Due ($)
Payment Due ($)
Due Date
Monthly Payment ($)
Other Information

Authorized Claimant*

*Checking the box below signifies the "Authorized Claimant" is legally responsible for actions
based on information submitted to Imperial Recovery Agency.

I have read and understand the Indemnification Agreement.
Imperial Recovery Agency are members of the National Finance Adjusters, American Recovery Association, Inc. for repossession specialists, Time FInance Adjusters, Florida Association of Licensed Recovery Agents, Inc., California Association of Licensed Repossessors, and the Lexington Chamber of Commerce and are bonded for $3 Million Dollars.

For General Information: info@imperialrecovery.com
or call:
1-800-365-REPO (7376)

Toll Free Assignment Orders.
On Line Assignment Orders.
American Recovery Association Florida Association of Licensed Repossessors California Association of Licensed Repossessors National Finance Adjusters National Association of Fraud Investigators Time Finance Adjusters
©2005 Imperial Recovery Agency