Proud member of:
American Recovery Association &
Rocky Mountain Repossessors Association





Pennsylvania Repos
Maryland Repos

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C & S Towing and Recovery
1355 S George Street
York, PA 17403

Ph: 717.848.8220
Fax: 717.848.8765

Online Assignment Form

* Required Fields
*Lienholder:
*Address
*City:
*State:	*Zip:
*Phone:	Ext:
Fax:
*E-mail:
*Collector:
*Debtor:
*Address:
*City:
*State:	* Zip:
Phone:
E-mail:
SSN:
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:	Involuntary Voluntary Contact and Collect Condition Report DMV MVR
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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