Request for Stop Notice
Complete as much information as you have
Your Company Information
Your Company Name
(Required)
Your Company
Email Address
(Required)
Your Company
Contact Person
(Required)
Materials/Labor Provided
(Required)
Job Information
Original Preliminary
Notice Number
Name of company preparing preliminary notice if other than Arizona National Lien and Bond Co.
(Please fax a copy of the original preliminary notice to (480) 452-0351)
Date You
First
supplied materials,
equipment and/or services
(Required)
Date You
Last
supplied materials,
equipment and/or services
(Required)
Is this project complete?
Yes /
No
(Required)
Date occupancy permit issued
Job Name
(Required)
Job Address
Job City, State
,
Job County
Customer Information
Customer Name
(Required)
Customer Address
Customer City, State, Zip
,
,
Customer Phone & Fax
,
(Required)
Exact Contract Amount
Value Actually Furnished
Amount of Payments Received
Balance Amount Due
(After Credits/Offsets)
(Required)
Include additional costs to offset
potential collection expenses
Usually this additional cost includes the
cost of lien filing plus 30% of lien amount
Yes /
No
(Required)
Please indicate amount for total
costs to be added if different than this
Property Information
Property Owner Name
Property Owner Address
Property Owner
City, State, Zip
,
,
Lender Information
Lender Name
Lender Address
Lender City,
State, Zip
,
,
Lender Phone
Lender Contact Person
Loan Number
General Contractor Information
General Contractor Name
(Required)
G/C Address
G/C City, State, Zip
,
,
G/C Phone & Fax
,
(Required)
Additional Information
Comments
Contact
/
Company
/
Services
/
F.A.Q.
/
Forms
/
Timetable
/
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