Placement Form

If you would like to place an account with us right away, feel free to use the form below. Once information is received, we will enter the account into our system and begin work immediately. However, we ask that you fax or email the following account back-up information to us - it will greatly increase our chances of recovery:

Victory Recovery Services Placement Form:

* Required

Date:*
Debtor:*
Social Security#:*
Co-Debtor:
Social Security#:
Last Known Address:
References:

Description of Collateral:
Year:
Make:
Model:
Color:
Serial/VIN#:*
Selling Dealer:
Amount Due:
Last Pay:
Balance:
Your Account #:*
Your name: *
Your email: *
Your telephone:*
Your fax:
Charge Off Date/DPD:*
Your company:*
 

Please provide any additional references, Credit Application, and any collection notes that would be helpful.



Please forward all new placements to FAX # 866-211-3570. Sorry for the inconvenience."