J&S recovery inc.

DEBTOR’S NAME

Po box 31292

DEBTOR’S ADDRESS

Billings, MT 59107

CO-DEBTOR

Fax: 406-252-7259

PHONE

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DATE OF ORDER DATE REPOSSESSD PLACE OF EMPLOYMENT

PLEASE INCUDE A COPY OF LIEN FILING ___________________________________

SOCIAL SECURITY #

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ANY OTHER PERTINENT INFORMATION

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THIS IS YOUR AUTHORIZATION TO ACT AS OUR AGENT TO COLLECT

AND/OR REPOSSESS ON SIGHT. The above named, who has in his/her possession:

YEAR: MAKE: MODEL:

COLOR: PLATE #: VIN:

This will certify that we have the right to the immediate possession of the above named

collateral. We agree to indemnify and hold you harmless from and against any and all claims,

losses, and actions, except unlawful acts of your firm. You will not be held liable for the

mechanical operation of the vehicle as listed above, for insurance protection except in

case of your neglect. Nothing contained herein should be construed to authorize you to

violate City, County or State laws. Your special immediate efforts will be appreciated.

Please acknowledge and keep us fully informed

Subscribed and sworn to before me on this
__________Day of __________, 20____

______________________________

Notary Public for the State of____________

Residing at__________________________

My Commission expires: ________________

X

AUTHORIZED BY:

SALES LOT/LENDER NAME

ADDRESS

CITY STATE ZIP

PHONE FAX