Interstate Adjusters S.A., Inc - Repossession Firm in San Antonio Texas

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Interstate Adjusters S.A., Inc.
San Antonio, TX 78265
Fax 210.646.8677

Your Email Address (Required)

Legal Owner Information

Legal Owner
Owner's Address
Assigned By		Date
Phone		Extension
Fax		Watts/800 #

Debtor Information

Debtors Name
Home Address
Employer
Work Address
Home Phone		Work Phone
DOB		SS #
Spouse's Name
Spouse's DOB		Spouse's SS #

Collateral Property Information

Year		Make
Model		Color
License #		State
Ignition Key #		Trunk Key #
VIN #

Loan Information

Loan Number		Balance
Past Due Date		Monthly Payment
Past Due Amount
Assignment Type

The issue of this assignment requires a price quote in advance Yes No

Special Instructions

Storage Instructions

This is authorization to act as our agent to collect or reposses the above collateral. We agree to indemnify, and hold 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 reposses 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.

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