Online Assignment Form

*All fields marked with an asterisk are required

*Lienholder:
*Address:
*City:
*State:    *Zip:
*Phone:    Extension:
Fax: 
*E-mail:
*Collector: 

*Debtor:
*Address: 
*City:
 *State:     *Zip: 
Phone:
Fax:
E-mail:
SSN:
Date of Birth:

Debtor's POE:
Job Title: 
Address: 
City:
State:    Zip:
Phone:    Extension:

Co-Maker:
Address: 
City:
 State:     Zip:
Phone:
Fax:
E-mail:
SSN:
Date of Birth:

Co-Maker's POE:
Job Title: 
Address: 
City:
State:    Zip:
Phone:    Extension:

*Collateral Year:   
*Collateral Make:  
*Collateral Model: 
 
*Plate: 
*State: 
*Color: 
 
Key Numbers: 
*Vehicle Identification Number: 

Loan #:
Past Due Date: 
Past Due Amount: 
Monthly Payment:
Loan Balance: 
Assignment Type: 


Note: Should you have any information regarding family members, relatives of the debtor, or any unique or defining information that would be helpful in aiding us in the recovery of your vehicle, please enter that information in the "Instructions" space below.
*Authorized by:
*Date:
Please type in the box the numbers and/or letters you see.
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Hall Recovery Specialists
1315 N Cockrell Hill Rd
Duncanville, TX 75116

Toll-Free 800.336.4176
Ph 972.298.3338
Fax 972.298.3584

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