APS - Asset Recovery Request
Client/Company Name? *
What type of business are you with? *
Completed by (your name): *
Physical Address: *
Phone Number: *
Fax Number: *
Email Address (for status updates): *
Are You a Repeat Client? *
New Clients, how did you discover our services? *

New Clients: we would like to know how you discovered our services, co-worker, internet search, email, friend, napps, servenow??

Repeat Clients: please type NA in this field.
Service Needed? *
 Select Option  
 Voluntary Repossessions $200.00 in Pulaski County  
 Involuntary Repossessions $300.00 in Pulaski County 
 Collect Funds Only  
 Other Services  
Lien Holder/Legal Owner: *
Loan Account Number: *
Debtors Name: *
Debtors Last Known Home Address: *
Debtors Last Known Work Address: *
Debtors Last Known Home Phone: *
Debtors Last Known Work Phone: *
Debtors Social Security Number: *
Debtors Drivers License Number: *
Type N/A if unknown.
Debtors Date of Birth: *
Type N/A if uknown.
Cosigners Name: *
Type N/A if there is no Cosigner.
Cosigners Home Address: *
Type N/A if there is no Cosigner.
Cosigners Work Address: *
Type N/A if there is no Cosigner.
Cosigners Home Phone: *
Type N/A if there is no Cosigner.
Cosigners Work Phone: *
Type N/A if there is no Cosigner.
Cosigners Social Security Number: *
Type N/A if there is no Cosigner.
Cosigners Drivers License Number: *
Type N/A if there is no Cosigner.
Cosigners Date of Birth: *
Type N/A if there is no Cosigner.
Vehicle (Year, Make & Model): *
Vehicle Color: *
Vehicle Key Code: *
Type N/A if there is no key code.
VIN#: *
Payment Due Date: *
Past Due Amount: *
Unpaid Balance Amount: *
Minimum Amount for Collections? *
What is the Minimum Amount that you will accept in order for us to leave the Vehicle??? Type N/A if this is a REPO only request.
Is the KEY ready for Pick Up? *
If there is NO KEY available, we have a Tow Truck Service for additional fees (see website for details).
Vehicle Drop Off Location: *
We can deliver the Recovered Asset to our office in Little Rock and call you once it is ready for Pick Up or we can deliver it to your office (if located) in Pulaski County, AR.
Special Instructions: *
Additional Information: *
Proof of Lien (1):
You can upload the Proof of Lien in this field, we are unable to complete any Asset Recovery Request without Proof of Lien. If you are unable to upload it, you may fax it to us at (501) 888-5372 24/7.
Upload Document (2):
If you have any documents that you would like to send us, you may upload them here. If not, skip this option.
Upload Document (3):
If you have any documents that you would like to send us, you may upload them here. If not, skip this option.
Upload Document (4)
If you have any documents that you would like to send us, you may upload them here. If not, skip this option.
Upload Document (5)
If you have any documents that you would like to send us, you may upload them here. If not, skip this option.
Select Payment Method: *
Select your preferred Payment Method in this field, you can upload a Check "Copy" on this page (we can process it Electronically) or the next page will prompt you for payment by Online Secure Check, Visa or Master Card or PayPal Account.

Repeat Clients: You can select to Charge Card on file and Pre-Authorize a Credit Card Payment for all future Orders to save time on the next page.

Hold Harmless Agreement:

We (the client) do hereby authorize Action Process Service & Private Investigations to repossess the security listed above and certify that we are the legal owner of the above described security. We (the client) further certify that the information supplied concerning this account and its present status is accurate. We (the client), do hereby agree to release, acquit and forever discharge Loretta Foster, Action Process Service & Private Investigations, LLC, The Towing Service Company contracted for services and/or any of its agents or representatives from any lawsuits, liabilities or cause of actions which may arise from the settlement and will not hold them accountable for any personal items or belongings inside the property at the time recovered.

By Typing my Name below, I am Acknowledging that I am a true representative of the Company listed within and that I have proper Authority to place this order for Asset Recovery Services, as well as approve the Hold Harmless Agreement within on behalf of the Company (client) listed within.
Electronic Signature (type name): *
I have read and agree to the terms set fourth within on behalf of the Company/Client listed for the request.
Title: *
Date Completed (type date): *
Email *