Dealer Auto Loss Notice

Phone # 972-855-3585
Fax # 877-837-2066
DATE : LOAN NUMBER :
NAME OF DEALER :
ADDRESS :
DEALER’S CONTACT :
DEALER PHONE NUMBER :
DEALER’S CONTACT EMAIL :
NAME OF BORROWER :
POLICY NUMBER :
DATE OF LOSS :
( Date of Accident or Date of Repossession)
LOCATION OF VEHICLE :
STREET ADDRESS or PO Box :
CITY : STATE : ZIP :
PHONE NUMBER AT LOCATION OF VEHICLE :
CONTACT PERSON AT VEHICLE LOCATION :
DESCRIPTION OF DAMAGE TO VEHICLE :
REPOSSESSED? :  Yes No
YEAR/MAKE/MODEL OF VEHICLE :
VEHICLE IDENTIFICATION NUMBER - VIN (LAST 6 DIGITS) :
ATTACH ADDITIONAL REQUIRED DOCUMENTS (or fax to 877-837-2066) :

ADDITIONAL DOCUMENTATION REQUIRED :

REPO
AFFIDAVIT OF REPOSSESSION
COPY OF PAY HISTORY
COPY OF SECURITY AGREEMENT (NOTE)
COPY OF TITLE
NON REPO
COPY OF POLICE REPORT
COPY OF PAY HISTORY
COPY OF SECURITY AGREEMENT (NOTE)
COPY OF TITLE
THEFT
THEFT REPORT
COPY OF HISTORY AND LOAN INQUIRY
COPY OF SECURITY AGREEMENT (NOTE)
COPY OF TITLE
ANY PERSON WHO KNOWINGLY & WITH INTENT TO
INJURE, DEFRAUD, OR DECEIVE ANY INSURER, MAKES
ANY CLAIM FOR THE PROCEEDS OF AN INSURANCE
POLICY CONTAINING ANY FALSE, INCOMPLETE OR
MISLEADING INFORMATION IS GUILTY OF A FELONY
OF INSURANCE FRAUD.