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Omni Recovery Service
P.O. Box 55423
Birmingham, Alabama 35255

Omni Recovery Service
Hazel Green, AL 35750

Phone: 205.833.2733
Fax: 205.838.1160




Recovery Specialist
Insurance Group



CARS Certified



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