Submit Online Repo Order

** Unknown client orders will not be honored **

Client Information:

Your Name*

Company Name*

Your E-mail*

Your Phone Number*

Area Code

-

Phone Number

Account Information:

Lienholder*

VIN*

Year*

Make*

Model*

Color

License Plate Details

Customer Information:

Customer Name*

First

Last

Middle

Customer Date of Birth

/

day

month

year

Various Customer Details

Customer Address*

Street AddressCityStateZip Code

Cobuyer Information:

CoBuyer Name

First

Last

Middle

CoBuyer Date of Birth

/

day

month

year

Various CoBuyer Details

Cobuyer Address

Street AddressCityStateZip Code

Additional Information:

Additional Address 1

Street AddressCityStateZip Code

Various Address 1 Details

Additional Address 2

Street AddressCityStateZip Code

Various Address 2 Details

Additional Address 3

Street AddressCityStateZip Code

Various Address 3 Details

Confirm*

- This is your authorization to repossess and impound the above-described collateral which is covered by a defaulted installment contract or lease agreement. We name Emerald City Recovery, LLC (ECR) as our exclusive agent for repossessing the above described vehicle. This means that any agent we have previously engaged is no longer authorized to repossess this vehicle unless they are subsequently authorized to do so by ECR. - We agree to indemnify, defend, and save you harmless from and against and all claims, losses and actions, except for your unauthorized efforts and/or actions which may be acts of our company, its officers, employees or agents. - Should the vehicle be found with repairs charges and or storage charges incurred in such an amount that they exceed our estimate of the value of the vehicle, ECR. Fee will never exceed the salvage value of the vehicle or we will tender a negotiable title to the vehicle in lieu of your fees. I understand that I will be charged a $200.00 CLOSE FEE if the vehicle is not recovered within 60 days. - We also agree that if the debtor(s) should surrender the collateral to ECR or ECR retrieves the vehicle during the term of the agreement this will be deemed to be repossessed by ECR, I will be charged our agreed upun involuntary repossession fee. Out of Area Fees will be discussed prior to collection and added to our service fee. (out of town rates available upon request). - We also agree that if the debtor(s) should surrender the collateral to Lender/Agent during the term of the agreement this will be deemed to be Voluntary Repossession and if requested by the Lender/Agent for ECR to retrieve the vehicle the set fee for this will agreed upon prior to service. Anyone else is understood to mean but is not limited to body shops, police impound slots, other repossesses or to any facility under our direct or indirect control. - Your special immediate efforts will be appreciated.