C & S Towing and Recovery

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Proud member of
Allied Finance Adjusters

C & S Towing and Recovery
P.O. Box 13
Shrewsbury, PA 17361

Toll-Free:
866.466.REPO (7376)
Ph: 717.227.9695
Fax: 717.227.9680

Online Assignment Form

* Required Fields

*Lienholder:

*Address

*City:

*State:

*Zip:

*Phone:

Ext:

Fax:

*E-mail:

*Collector:

*Debtor:

*Address:

*City:

*State:

* Zip:

Phone:

E-mail:

*SS#:

*DOB:

*Employment:

Address:

City:

State:

Zip:

Phone:

Ext:

Fax:

*Collateral (Year, Make, Model):

Plate, State & Color:

Key Codes:

* VIN:

*Loan Acct #:

Past Due Date:

Mo Paymt:

Loan Balance:

*Assignment Type:

This is your authorization to act as our agent 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, however, as such may be caused by or arise out of negligence or unauthorized acts on the part of you, your company, its officers, employees or its agents.

*Authorized by:

*Date:

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