DEFAULT JUDGMENT AUTO LOAN

Client*

Email of Client Contact*

Multiple Defendants* YesNo

Defendant*

Address Line 1

Address Line 2

Co-Defendant*

Address Line 1

Address Line 2

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

Name of the Agreement

Description of Vehicle*

Vehicle Identification Number (VIN)

Amount Owed (Principal and Interest) $

Date as of

Interest Rate*

Costs* $

Attorneys' Fees

Court Type* MunicipalCommon Pleas

Which Municipal Court? (e.g., Franklin County etc.)

Which Common Pleas Court?

Case Number

Judge

Defendant Service Method Certified MailOrdinary MailPersonal ServicePublicationOther

If "Other", please describe the method of service in the "Comments" section below.

Date Defendant Served