NEW ENGLAND ADJUSTMENT BUREAU
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Violent Debtor Report
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Indicates required field
Agent Name
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First
Last
Last 6 of Vin
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Are the police involved?
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Yes
No
Does the dash cam video need to be reviewed?
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Yes
No
Unknown
Please describe in detail the violent debtor. Include in depth exactly what happened. Include dates, times, people involved. The more detail the better.
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ANYTHING ADDITIONAL TO ADD ABOUT YOUR SHIFT INCLUDING LESS THAN SERIOUS MATTERS THAT SHOULD ADMINISTRATION SHOULD BE AWARE OF.
Submit
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