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COMPLAINT DEALER ASSIGNMENT QUESTIONNAIRE

    PARTIES

    Full legal business name as it appears on Secretary of State filings

    YesNo

    Defendants*

    Co-Defendant*

    If there are more than TWO defendants, please provide the name and address of the additional defendants in the "Comments" section at the bottom.

    AGREEMENT

    Description of Vehicle

    AMOUNT OWED

    COURT DETAILS

    RELATED DOCUMENTS & COMMENTS

    Please submit all related documents through our secure dropbox located at this link.

    Please note: Multiple documents may be submitted at once simply by using either the"Shift" or "Ctl" keys.

    Loan SummaryNoteSecurity AgreementOther