Consent, Release, & Hold Harmless Agreement

Your Debtor Info  
Name:
 
Social Security #:
Home Address:
                                   Work Address:
Phone home:
Phone work:

* Vehicle Year: * Vehicle Make:
* Vehicle Model:
 
* VIN#:
* Plate:
* Color:
*
Involuntary  Voluntary  Impound  Collection
Special Instructions:

Please note: This is your authorization to act as our agent(s) 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 claims, except such caused by or arise out of negligence or unauthorized act on the part of you, your company, its offices, employees or its agents. We also agree that if the debtor or his agent(s) should surrender the collateral to anyone else during the term of this agreement , it will be deemed to have been repossessed by Professional Recovery.
Anyone else is understood to mean but not limited to body shops, mechanics, police impound lots, other repossessors or to any facility under our direct or indirect control. Close out fee's flat $250.00.
Your special immediate efforts will be appreciated.


Client/Customer Info
Date:
 
Company/Lien Holder:
                                     Address:
Telephone:
Fax:




1105 W. 15th Street . Suite One . Bemidji, Minnesota .  56601 . Fax 612-545-1884 ~ Phone 218-308-1568