Text Box: Skip Tracing Claim Transmittal Form Insurance Company   Confidential  

 

               

 

    

 

 

 

     Company        _____________________________                     

      Address           _____________________________

      City State Zip   _____________________________

 

 

      Mr/Ms                 ___________________________________

      Telephone        _____________________________

      Fax Number     _____________________________

 

                  To: Sales Department

Roquemore & Roquemore, Inc.

800-500-7855 ext. 220, Fax 972-226-9720

Email: info@roquemore.com

 

 

      Lenders Name                               ____________________________________________

      Subjects Name                              ____________________________________________

      Social Security #                           ____________________________________________                  

      Claim Number                               ____________________________________________                  

      Last Known Mailing Address         ____________________________________________

                                                            ____________________________________________

      Collateral                                       ____________________________________________

      Vin #                                              ____________________________________________

      Potential Loss                                ____________________________________________                  

      Date Claim will be Paid                 ____________________________________________

 

      To deny this claim, what do you need found?          

Text Box:   q      Repo on Site q      Collateral or Maker or Co-Maker  & Advise           

 

         

 

 

 

Approved By   _______________________________  Date  _____________________

Important!  Please attach copies of the following:

Credit Application, Collector Notes, Loan Contract, Security Agreement, and Title.