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Client Intake Form
Vehicle Release Form
Creditor/Bailiff Inquiry Form
FAQ’s
Client Intake Form
Client Intake Form
Vehicle Release Form
Name:
Phone Number:
Email:
Secured Creditor:
Are you going through a debt restructuring process
Yes
No
If Yes
Consumer Proposal
Bankruptcy
Other
Name of company assisting you with your debt:
Name of your Debt Advisor:
Debt Advisor’s email address:
Other Information:
Pick Up Information:
Pick up contact name:
Pick up contact email address:
Pick up contact phone number:
Pick up location:
Same as your Information above
Vehicle/Unit Information:
Year:
Make:
Model:
Color:
VIN:
Condition:
drivable
not driveable
unsure
# Set of keys:
1 set
2 sets
3 sets
Drivetrain:
front wheel drive
rear wheel drive
AWD
4WD
Battery:
charged
dead
unsure
Upload a copy of the registration for vehicle(s), trailer, recreational vehicle and/or other asset(s)
Preferred Pick-Up Day & Time
Weekday:
Monday
Tuesday
Wednesday
Thursday
Friday
None
Time
Morning
Afternoon
Evening
Weekend:
Saturday
Sunday
None
Time
Morning
Afternoon
Evening
Agree to receive SMS texts and email messages*
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