| Today's Date: |
Wednesday, April 2, 2025 |
| Lienholder Information |
| Your Name: |
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| Lienholder Phone Number: |
Format: 999-999-999
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| Lienholder Fax Number: |
Format: 999-999-999 |
| Lienholder E-mail: |
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| Lienholder Company Name: |
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| Address: |
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| City: |
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| State: |
2-digit state abbreviation |
| Postal Code: |
Format: 99999-9999 |
| Repossession Type (Check One):
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Involuntary
Voluntary
Door Knock
Other
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| Debtor Information |
| Debtor's Full Name: |
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| Social Security Number: |
Format: 999-999-9999 |
| Last Known Address:
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| City:
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| State: |
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| Postal Code: |
Format: 9999-9999 |
| Last Know Phone Number: |
Format: 999-999-999
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| Last Known Employer:
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| Employer's Address: |
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| Employer's Phone Number:
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Format: 999-999-999 |
| Spouse's Name: |
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| Spouse's Employer: |
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| Spouse's Phone Number: |
Format: 999-999-999 |
| Description of Collateral |
| VIN: |
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| Make: |
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| Model: |
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| Year: |
Format: 2001 |
| Color: |
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| Body Type: |
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| License Plate Number: |
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| State Registered In: |
2-digit state abbreviation |
| Ignition Key Code: |
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| Trunk Key Code: |
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| Loan Information |
| Loan Type (Check One): |
Purchase
Lease
Other
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| Contract Date: |
Format: 99/99/99
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| Contract Number: |
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| Original Amount: |
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| Payment Amount: |
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| Last Payment Date: |
Format: 99/99/99 |
| Delinquent Amount: |
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| Additional Information |
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| Email Opt-In:* |
Yes
No |
| From time to time, All Star Recovery may want to contact you regarding company or industry news. By checking "Yes" in
the Email Opt-In field, this gives us permission to occasionally send you emails not related to your specific workorders. If you prefer not to
be contacted by us regarding miscellaneous information, please check "No" in the Email Opt-In field. Be assured that All Star Recovery will not share
your information with third-parties. Our business relationship and your privacy are very important to us. |
| |
| Please Read: Upon submitting this form, as the LEGAL OWNERS of the above described property, the lienholder authorizes All Star Recovery LLC to act as the lienholder's agent and seize the property described above on sight without notice, and hold said property subject to the lienholder's orders.
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