Preliminary Notice Request
Please fill out as much information as you have in the form below. If you have a project information sheet supplied by the General Contractor please fax to (480) 558-3527.
General Information
Rush (Fee $20.00)
To be processed within 48 hours of receipt
Yes /
No
Job Type
Residential–Privately Owned
Commercial
State/Municipal Owned
Federal
(Required)
Type of Service Provided
(Check all that apply)
Labor
Supplies
Other Services
Specially Fabricated Materials
Rent/Lease Equipment
Today's Date
Job Number
Your Company Name
(Required)
Your Email Address
(Required)
Labor/Materials Provided
Date Job Started
(Required)
Estimated Amount
(Required)
Customer Information
Customer Name
(Required)
Customer Address
Customer City, State, Zip
,
,
Customer Phone & Fax
,
(Required)
Job Information
Job Name
(Required)
Job Address
Or Cross Streets
(Required)
Job City, State
,
Job County
Owner Information
Owner
Owner Phone
Owner Address
Owner City, State, Zip
,
,
Lender Information
Lender
Lender Phone
Lender Address
Lender City, State, Zip
,
,
General Contractor Information
General Contractor(G/C)
Entity contracted with the property owner
G/C Phone
G/C Address
G/C City, State, Zip
,
,
Agent Information
Bonding Agent
For PAYMENT Bond
Agent Address
Agent City, State, Zip
,
,
Bond #
Additional Information
Comments
Contact
/
Company
/
Services
/
F.A.Q.
/
Forms
/
Timetable
/
Associations
/
Sign Up
©2008 Lien and Bond Services, LLC. All Rights Reserved.
