MICHIGAN CREDITORS SERVICE, INC. Michigan State License: No. 23 4500 Remembrance Road N.W. email@example.com Grand Rapids, MI 49544-1122 National Finance Adjusters, Inc. (616) 453-6447 (616) 453-3694 (616) 453-1345 Fax American Recovery Association, Inc. Repossessions & Collections Time Finance Adjusters, Inc. Customer Information: Date: Account #: Name: Address: City: State: Zip: Phone: ( ) SS#: D.O.B.: / / Employment Information: Occupation: Employer: Address: City: State: Zip: Reference: Type Of Obligation: Payment Information: Security Agreement Total Past Due Payments: Mortgage Present Unpaid Balance: Note Present Past Due Date: Instructions: Date Of Loan: Repossess on Sight Original Amount: Demand Balance In Full or Repossess Number of Payments Made: Demand Delinquent Payments or Repossess Date of Last Payment: Interview in Endeavor to Work Out Payment Plan Dealer’s or Co-Maker’s Name & Address: If Security is Repossessed: Please Send Condition Report Obtain three (3) bids for our consideration Inform Us Where Security it Stored so we can Arrange for its Return Year: Body: License #: Make: Key #: License Year: Model: Serial #: License State: Color: Extras: Comments: Return Address: Phone: ( ) Fax: ( ) (Authorized Signature) SO THAT WE MAY BETTER SERVE YOU, AT THE MOST REASONABLE PRICES IN OUR MARKET PLACE, PLEASE FAX OR E-MAIL ALL REQUESTS FOR UPDATES, NEW INFORMATION, AND ACCOUNT. INCLUDE DEBTOR NAME, CITY ASSIGNED, VEHICLE MAKE AND MODEL. ALSO INCLUDE YOUR FAX #, VOICE #, AND THE INDIVIDUAL TO WHOM RESPONSE SHOULD BE DIRECTED.
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