Use this form if you have collateral that you would like Lizard Lick Towing and Recovery, LLC to recover for you. This form is organized for vehicle recoveries, but we do recover collateral of ALL types. Please contact us for more information if you have questions.
Please provide as much information as possible. There are 6 fields denoted with a red asterisk * that MUST be filled in order for LLTR to proceed.
Your Information
Collateral Information
Vehicle Make
Vehicle Model
Vehicle Year
Vehicle Identification Number
Color
License Plate #, State
Ignition Key #
Trunk Key #
Debtor Information
Debtor's Name
*
Home Address
Home Phone #
Work Phone #
Date Of Birth
SS#
Spouses Name
Spouses Date of Birth
Spouses SS#
Loan Information
Loan #
Past Due Date
Past Due $
Assignment Type
Balance $
Monthly Payments $
Legal and Special Information
The issue of this agreement requires a price quote in advance
*
Yes
No
Special Instructions
Storage Instructions
* This is authorization to act as our agent to collect or reposses the above collateral. We agree to indemnify, and hold 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 reposses 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.
