Submit an Assignment

Southern Adjustment Services, Inc.
Services Available from Vero Beach down to the Florida Keys, with affiliating agents nationwide

Corporate Headquarters
P.O.Box 8923
Pembroke Pines, Florida 33084
Nationwide Assignment Center
Phone : 1.800.771.9999
or Fax : 1.954.797.4964




Lienholder:

Address:

City: State: Zip:

Phone: Extension: Fax:

E-mail:

Collector:




Debtor:

Address:

City: State: Zip:

Phone: Extension: Fax:

E-mail:

Social Security Number and Date of Birth:




Employment:

Address:

City: State: Zip:

Phone: Extension: Fax:




Collateral Year, Make & Model:

Plate, State & Color:

Key Numbers:

Vehicle Identification Number:




Loan #:

Past Due Date:

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.

This is your authorization to act as our agent to collect or repossess the above collateral. We agree to indemnify and hold you 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 repossess 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.

Authorized by:Date:

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Any questions? Please contact us at 1.800.771.9999.

You may also contact us via email at: