Omni Recovery Service
2602 Alton Road
Birmingham, Alabama 35210

Toll Free: 877.808.6664
Local: 205.833.2733
Fax: 205.838.1160


Recovery Specialist
Insurance Group


Allied Finance Adjusters


A+ Rating

ONLINE ASSIGNMENT FORM


*Lienholder:
Address:
City:
State:    Zip:
Phone:    Extension:
Fax: 
E-mail:
Collector: 

Debtor:
Address: 
City:
 State:     Zip:
Phone:
Fax:
E-mail:
SSN :
Date of Birth:

Debtor's POE:
Job Title:
Address: 
City:
State:    Zip:
Phone:    Extension:

Co-Maker:
Address: 
City:
 State:     Zip:
Phone:
E-mail:
SSN :
Date of Birth:

Co-Maker's POE:
Job Title:
Address: 
City:
State:    Zip:
Phone:    Extension:

Collateral Year:
Make:
Model:
Plate:
State:
Color:
Key Number:
Vehicle Identification Number:

Loan #:
Past Due Date: 
Past Due Amount: 
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.

Authorized by:
Date:
*All fields marked with an asterisk are required