Request for Intent to Lien Notice
In order to process your Intent to Lien request we will need the following faxed or delivered to our office:
Intent to Lien 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 $20.00)
To be processed within 5 working days
Yes /
No
I am interested in discussing how Lien and Bond Services can assist me in collecting this past due amount from my customer.
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 33% 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)
Your Information
Your Company Name
(Required)
Your Name
(Required)
Your Title
(Required)
Your Email Address
(Required)
Contact Phone
(Required)
Additional Information
Comments
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