“Claim of Lien” Request

Fill out this form online, press the submit button at the bottom and we will confirm via email.

YOUR COMPANY INFO:

Your Company Name:
Your Company Telephone Number:
Name of person filling our form:
Email: **(This is where the Claim request confirmation will be sent)

PROPERTY OWNER INFO: 

Property Owner Name:
Mailing address:
City:
State:
Zip:

JOBSITE INFO: (Info about location of work)

Folio or Pacel ID:
Job Site address:
Job city:
Job state:
Job zip:
Job County:

CONTRACTOR INFO: (Who were you Hired by?)

Contractor Name:
Mailing address:
City:
State:
Zip:

SCOPE OF WORK: (What kind of work was done?)

Scope of Work:
First Day on Job: 
Last Day on Job: 
Total Value of Job: 
Amount Owed: 

NOTICE TO OWNER INFO:
USPS Certified Mail Receipt Number for Notice to Owner (If Known)

Certified Copy of Lien to Owner? * Additional fee + USPS fees will apply
YesNo
** If you choose not to have us certify a copy to the Owner, it is up to you to send a copy of the Lien to the Owner within 15 days of the recording of the Lien.

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