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Basic Case Information
Company
StateWide Auto Trackers Inc.
Case Type:
Appraisal
Auction
Condition Report
Field Call/Collection
GPS Tracking
Impound Retrieval
Investigation
Involuntary Repo
Lease Turn In
MV Hit Lead
MVConfirm
Other
Passive Repo
Replevin
Storage
Transport
Voluntary Repo
Assignment Date:
Client:
StateWide Auto Trackers Inc.
Case Classification:
None
Case Worker:
Select...
Legal Owner:
Select Legal Owner...
Area of Operation:
None
Repo User:
Select...
Contact Person (Required)
Name:
Phone:
* - Person to contact to confirm this order.
Comments:
Please include Email and Fax # in comments (if applicable)
Asset Information (Required)
VIN:
Year:
Make:
Model:
Color/Description:
Asset Type:
5th Wheel
Aircraft
ATV
Boat
Box Truck
Car
JetSki
MiniVan
Motorcycle
Other
RV/MotorHome
Semi
Snowmobile
SUV
Travel Trailer
Truck
Van
Door Code:
Ignition Code:
Tag:
Tag State:
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces America
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Tag Expires:
Asset Details (Optional)
Doors:
Displacement:
# Cylinders:
Engine Type:
Trim:
Drive Type:
Trans Type:
Loan Amount:
Monthly Payment:
Balance:
Amount Past Due:
Past Due Date:
Payout:
Estimated Value:
Loan Date:
Interest Paid:
Principal Paid:
Trans Speeds:
Account #:
Debtor Information (Required)
Last Name, First Name:
,
SSN:
DoB:
Primary Address:
Address Format
Alternate Address:
Phone:
Alt Phone:
After Hours
Cell
Fax
Home
Impound
Other
Work
After Hours
Cell
Fax
Home
Impound
Other
Work
Employer Name:
Phone:
Employer Address:
Co-Debtor Information (Optional)
Last Name, First Name:
,
SSN:
DoB:
Primary Address:
Address Format
Alternate Address:
Phone:
Alt Phone:
After Hours
Cell
Fax
Home
Impound
Other
Work
After Hours
Cell
Fax
Home
Impound
Other
Work
Employer Name:
Phone:
Employer Address:
Options:
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