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Order Placement

4407 M-99 South

Homer, MI 49245

p. 877-895-3004

f. 877-895-3066

You can use our order placement form below or click here for a printable version that can be faxed to us at the fax number above or emailed to: orders@drsrecovery.com

**Bookmark this page in your browser for quicker access to our
online assignment form for future orders.**

Client Information

Name of form submitter:
Email address of form submitter:
Lien Holder:
Account #:
Assignment Type:	Assignment Type (Select one) Involuntary Voluntary Contact and Collect Condition Report DMV MVR
Address:
City:
State:
Zip:
Attention:
Title:
Phone:
Fax:
E-mail address:

Debtor Information

Debtor:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
SS#:
DOB:

Employer:
Address:
City:
State:
Zip:
Phone:
Employment Verified:	Yes No
Shift:	Day Evening Night

Co/Debtor:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
SS#:
DOB:

Vehicle Description

Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Identification Number: (Make sure you include all seventeen numbers)
Color:
Tag:
State:
No. of Doors:
Mileage:
Key Code(s):

Loan Information

No. of Payments Due:
Payment Amount:
Amount Due Now:
Due Date:
Loan Balance:
Contract Date:

Please add any information you have in regards to co-signer, family members, relatives of the debtor, or any unique or defining information that would be helpful in aiding us in the recovery of your collateral. Please enter this information in the space below.

This is your authorization to allow DRS to act as your agent to collect or repossess the above named collateral. DRS agrees to indemnify and hold you harmless from and/or against any and all claims, damages, losses and actions including reasonable attorney fees, resulting from and/or 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:

Any questions? Please feel free to contact us at 877-895-3004
Or you may also contact us via E-mail at:
orders@drsrecovery.com

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