Repossession/Research Order

The below named financial institution does today order immediate repossession/investigation of customers listed here in accordance with S.H.A.Chaper 26, Section 9-503 of the law. The following described vehicle and/or other collateral.

This is an explanation of the purpose of the form ...

                           Date     
                       Order #    

Name
Spouse
D.O.B.
Social Security #
Current Address
City
State/Province
Zip/Postal code
Phone
Previous Address
Employment
Position
Address
City
State
Zip/Postal code
Work Phone
Second Party C.S. Yes No
Phone
Relationship
Address
Loan Account #
Balance
Due for
Payment Amount
Make Model Year
Body Style   Color
License Plate
Serial Number
Ignition Key #
Door Key #

                     Your Name 
     Your Company Name
     Your Company Phone

Micsellaneous Instructions


IRB is a Federally protected trademark of IRB Recovery Inc. and Illinois Reclamation Bureau, Inc.
THIS SHEET TO BE USED FOR POLICE IDENTIFICATION AND BILLING ONLY. NOT TO BE GIVEN OR SHOWN TO SUBJECT OR AS RECEIPT AND ALL INFORMATION ON SHEET IS PROPERTY OF IRB. IF SHEET COMES INTO HANDS OF THIRD PARTY AND CONFIDENTIALITY IS BROKEN, THIRD PART ASSUMES ALL RESPONSIBILITY.
The aforementioned client agrees to indemnify and save IRB/and its agents harmless from and against any and all claims, damages, losses and action resulting from or arising out of our efforts to collect the above claim accept those which may be caused or arise out of the negligence or unauthorized act of your financial institution or company, its officers, employees, or agents including those which may arise out of the failure of your institution or any of the aforesaid persons to comply with applicable Federal and State Statutes.
Each order shall be phone verified. Shall be placed out immedially for recovery.

ŠThis is a protected, copyrighted document of IRB and may not be duplicated in full or in part.


Last revised: February 01, 2000