RECOVERY NETWORK OF NEVADA, INC.
3975 W. Hacienda, Las Vegas, NV 89119   702-repoman (office)     702-554-7222 (fax)
PILB LICENSE #1344
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::Date:___/___/2017             Assignment Type: Repo/Volo/Field Visit/Impound            						(circle one)
Your Account#:_______________          Client:_______________________
Address:______________________       City:________________________
State:_______         Zip Code:_______           Phone:___________________
Fax:____________________          Client Contact:____________________
Debtor:______________________________________________________
Address:____________________     City:______________    State:______
Home Phone:__________________     Cell:_________________________
Employment Address:__________________________________________
Employment Phone:___________     Additonal Phone:_______________
YEAR:__ __ __ __     MAKE:_________________MODEL:______________
PLATE:__________     STATE:____ KEY CODE:_______  COLOR:_______
GPS WEBSITE:______________________________________________
GPS USER NAME:______________         GPS LOGIN:________________
VIN:__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
This is your authorization to process for collection or repossession of the above described assignment. We agree to indemnify and save you harmless from and against all claims, damages, losses and actions resulting from or arising from our efforts to collect or repossess the above claim except, however such as may be caused or arise out of negligence or unauthorized acts of your company, its officers, employees or the officers or employees of such agents.