Fax To: Southern Arizona Repossession Services

REPOSSESSION ORDER FAX TO: SOUTHERN ARIZONA REPOSSESSION SERVICES 2628 W VERBENA AVE, TUCSON AZ 85705 TEL 520-292-1200 FAX 520-293-7724

REPO TYPE: DATE OF ORDER: 9/2/2009 Client: ______Phone No. : ______Ext ______Client Address: ______Assigned By: ______Fax: ______E-mail ______Account # : ______

Debtor's Name: Co-Maker:

Address: Address:

Phone: Phone:

DOB: DOB:

SSN: SSN:

Employer: Employer:

Address: Address:

Phone: Phone: Collateral Year: ______Make: ______Model: ______Vin #: ______License #: ______Exp: ______State: ______Color: ______Key Code – Ign. ______Key Code - Trunk/Door: ______Account Information Balance Due: ______Past Due Amt: ______Past Due From: ______Pmt Amt: ______Other Information ______Special Instructions:

**********For SOUTHERN ARIZONA REPOSSESSION SERVICES INC. Use Only********** Car Recovered Info. Date: ______Time: ______By: ______Address: ______Police Notified Yes No Agency: ______PR#:______