DEFAULT JUDGMENT AUTO LOAN

Client*

Email of Client Contact*

Multiple Defendants* YesNo

Defendant*

Address Line 1

Address Line 2

[group group-Codefendent]

Co-Defendant*

Address Line 1

Address Line 2

[/group]

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

[group Municipal]

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

[/group]

[group CommonPleas]

Which Common Pleas Court?

[/group]

Case Number

Judge

Defendant Service Method Certified MailOrdinary MailPersonal ServicePublicationOther

[group Other]

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

[/group]

Date Defendant Served