Collateral Recovery Request
*In the state of Wisconsin repossession is governed by the Wisconsin Consumer Protection Act.
We recommend consultation with your legal department prior to requesting collateral
recovery.*
Assignments
Lien Holder Information
Account Number
Lien Holder
Lien Holder Address
State
 Zip
City
Lien Holder Phone
Lien Holder Agent
Fax
Email
Collector
Debtor Information
Name
Address
City
 State
 Zip
Social Security Number
Date of birth
Phone
Work
 Alternate
Employer
Employer address
City
 State
 Zip
Co-debtor Information
Name
Address
City
 State
 Zip
Social Security Number
Date of birth
Phone
Work
 Alternate
Employer
Employer address
City
 State
 Zip
Collateral Information
Make
 Model
Year
VIN
Plate Number
 State
 Vehilce Color
Loan Balance
Loan Account Number
Loan Due Date
 Monthly Payment
Assignment Type
Involuntary Recovery
Voluntary Recovery
Field Visit
Any further information that maybe useful in the recovery of the collateral mentioned (such
as friends, family members or unique information) please enter it in the space below.

Hold Harmless
This agreement authorizes B Gone Auto Recovery to act as agents to
repossess the above described collateral, which is being held as security for
a defaulted contract.  We agree to indemnify and hold the agency harmless
from and against any and all claims or actions except for unauthorized or
negligent act of the agency or its employees.