Contact

272-770-0099

Please complete the form below to assign a recovery.

Once complete account manager will be assigned to your assignment. Please allow 24 hours

Blank Form (#3)

COMPANY NAME

This information is strictly confidential


DEBTOR INFORMATION

Please provide as much information is possible.


CO-DEBTOR INFORMATION

Please provide as much information is possible.


DEBTOR POE


CO-DEBTOR POE


VEHICLE INFORMATION


LOAN INFORMATION

This information is required in some states to be included in the recovery order.


Additional Information/References

HOLD HARMLESS

This is your authorization to act as our agent to collect or repossess on site all collateral which we assign to you which is covered by a defaulted contract. You are not to reassign if no longer in your service area without our prior written approval. We agree to indemnify and hold BLACKWATER RECOVERY, LLC harmless from and against any and all claims, including but not limited to court costs, reasonable attorney fees and other expenses of litigation including those arising from damage done to the collateral, except for unauthorized acts of your firm. This indemnification is granted as consideration for your acting as our agent. It is agreed that this contract is executed within your state and that the laws of your state shall be applicable. When there are two states involved, the laws of both states may be applicable.

I am assigning this claim for collection to BLACKWATER RECOVERY, LLC AND ITS AFFILATES. I am duly authorized by my company to make such an assignment. By typing my name in the box below and pressing the submit button, I am digitally signing this authorization.