Lien and Bond Services, LLC

90-Day Letter Request for Bond Claim

In order to process your bond claim request we will need the following faxed or delivered to our office:

90-Day Letter Request form below
Copy of Credit Application
Copy of terms-contract and/or scope of work
Copy of all invoices
Copy of any documents that state your customer is liable to pay legal or collection costs.
Copy of preliminary notice if prepared by a company other than Lien and Bond Services.

Complete as much information as you have.

General Information

Today's Date

Your Customer`s Name (Required)

Rush (Fee $100.00)
To be processed within 48 hours of receipt Yes / No

Job Information

Is this project complete? Yes / No (Required)

Date occupancy permit issued

Job Number (Required)

Job Name (Required)

Job Address
Or Cross Streets (Required)

Job City, State ,

Job County

Preliminary Notice Number (Required)

Name of company preparing preliminary notice
(If other than Lien and Bond Services)

Contract Amount

Actual Furnished Amount

Payments Made

Amount of Lien Claim
Balance Due (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

Date You First supplied materials,
equipment and/or services

(Required)

Date You Last supplied materials,
equipment and/or services

(Required)

Bonding Information

Bonding Company Name
(for Payment Bond)

Bonding Company Address

Bonding Company Phone & Fax ,

Bond Number

Your Information

Your Company Name (Required)

Your Title (Required)

Your Email Address (Required)

Additional Information

Comments