General Adjusting Service, Inc.

Submit an Assignment

Recovery Assignment

General Adjusting Service, Inc.
P.O. Box 18505
Indianapolis, Indiana 46218
Phone: (800) 489-4005
FAX: (317) 546-2385

Select The Branch Office [Required]

Lienholder:

Address:

City: State: Zip:

Phone: Extension: Fax:

E-mail:

Collector:

Debtor:

Address:

City: State: Zip:

Phone: Extension: Fax:

E-mail:

Social Security Number and Date of Birth:

Employment:

Address:

City: State: Zip:

Phone: Extension: Fax:

Collateral Year, Make & Model:

Plate, State & Color:

Key Numbers:

Vehicle Identification Number:

Loan #:

Past Due Date:

Monthly Payment: Loan Balance:

Assignment Type:

Note: Should you have any information regarding family members, relatives of the debtor, or any unique or defining information that would be helpful in aiding us in the recovery of your vehicle, please enter that information in the "Instructions" space below.

HOLD HARMLESS: 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. Should you have any additional information or instructions, please just type them in following this sentence. Start Here:

Authorized by:Date:

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Any questions? Please contact us at 317-546-2191, or 800-489-4005 or you may FAX us at: 317-546-2385.

You may also contact us via email at: art@gasindy.com or contact our Evansville Office: gas@evansville.net

General Adjusting Service, Inc.

Submit an Assignment

Recovery Assignment

General Adjusting Service, Inc. P.O. Box 18505 Indianapolis, Indiana 46218 Phone: (800) 489-4005 FAX: (317) 546-2385

General Adjusting Service, Inc.
P.O. Box 18505
Indianapolis, Indiana 46218
Phone: (800) 489-4005
FAX: (317) 546-2385