Repossession Order / Authorization to Repossess

Repossession Order / Authorization To Repossess

Lien Enforcement / Seizure Order

Year: ______Make: ______Model: ______Color: ______Doors: ______

Vin #:______Tag #: ______State: ______

Key Codes: ______GPS Company: ______GPS Number: ______

Borrower/Lessee: ______SS #: ______DOB: ______

Home Address: ______City: ______State: ____ Zip: ______

Home Phone: ______Cell Phone: ______Other Phone: ______

Employer Name: ______Employer Phone: ______

Employer Address: ______City: ______State: ____ Zip: ______

Spouse/Co-Borrower:______SS #: ______DOB: ______

Home Address: ______City: ______State: ____ Zip: ______

Home Phone: ______Cell Phone: ______Other Phone: ______

Employer Name: ______Employer Phone: ______

Employer Address: ______City: ______State: ____ Zip: ______

Lien Holder: ______Office Phone: ______Cell Phone: ______

Borrowers Account Number: ______Sale Date: ______

Loan Balance: ______Due Date: ______Payment Amount: ______Date Last Paid: ______

Comments/Special Instructions/Delivery Instructions: ______

The above listed information must be provided in its entirety, along with reference sheet, credit application, title, vehicle registration and default contract agreement, as mandated by Florida State Statutes, authorized to take all civil or criminal action allowed under Florida State Statute 493 & 818.08 of the criminal code. This authorization is for Florida Wrecker, its employees, contractors, sub-contractors, associates & affiliates to act as our agents to collect and/or recover on sight the above described collateral which is covered by a defaulted contract agreement between the lien holder & the borrower. This certifies that we have the right to take this action, as well as all penalties that may apply, as described in the default contract agreement. We agree to indemnify and hold Florida Wrecker, its employees, contractors, sub-contractors, associates & affiliates harmless from and against, any and all claims, losses and actions that result from this repossession, except unlawful or unauthorized acts by Florida Wrecker, its employees, contractors, sub-contractors, associates & affiliates. Florida Wrecker will be held liable for the mechanical condition of said collateral, only in case of neglect by Florida Wrecker, its employees, contractors, sub-contractors, associates & affiliates. Lien holder agrees to submit payment (upon delivery of the collateral) for our services as described on Should this repossession order become null and/or void for any reason (including payment made by borrower), lien holder will immediately notify Florida Wrecker (before collateral is recoveredFlorida Wrecker, its employees, contractors, sub-contractors, associates & affiliates) or be responsible for all applicable fees as described on

Authorized By (Print Name)SignatureDate