Lien Request Form - CRM Lien Services Inc.

Select State
Job State*
The State you have selected requires an attorney to process the lien. Please call our team at 800-773-5467 before completing this request.
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Date Requested
MM slash DD slash YYYY

My Company Information
Company Name*
Our Role
Company Address*
Street Address Address Line 2 City State ZIP Code
Company Phone*
Signer's Name*
First Last
The representative of my company who will be signing the lien
Signer's Title*

The title of the representative of my company who will be signing the lien.

Project Information
The following is the project information for the Real Property being improved or to be improved and referenced in this Lien
The Project is known as:*
Job PO or ID No.

Your identification for this project
Job Site Address*
Street Address Address Line 2 City State ZIP Code
Description*
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Start Date*
Month
Day
Year

Date you will START to supply materials, labor, or services to this project.
Start Date*

Date you will START to supply materials, labor, or services to this project.
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End Date*
Month
Day
Year

Date or Estimate Date, you will STOP supplying materials, labor or services to this project
End Date*

Date or Estimate Date, you will STOP supplying materials, labor, or services to this project
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Date all Invoices Were Due*
Month
Day
Year
Date All Invoices Were Due*
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Contract Amount
The total amount of your Original Contract.
Contract Amount

The total amount of your Original Contract.
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Amount Paid
The total amount of payments you received for this contract.
Amount Paid

The total amount of payments you received for this contract.
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Lien Amount*
The total of the amount being claimed in this Lien
Lien Amount*

The total of the amount being claimed in this Lien
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Interest Rate
Rate of interest agreed upon within our contract for this project.
Interest Rate

Rate of interest agreed upon within our contract for this project.

Customer Information
The following is my customer information (if the general contractor and your customer are one in the same, enter "Same as General Contractor" and enter your customer information in the General Contractor fields- This information is required)
My Customer's Name*
My Customer's Role*
Contact Name
First Last
Customer Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Customer's Phone
Customer's Email
Do we have your permission to contact your customer if needed to verify project information?*
- Yes
- No

Checkout
How would you like to pay?*
- CRM Account
- Credit Card
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Place this order using my CRM Account
Please enter your 5 digit CRM Account number or choose the Credit Card/Paypal Option. New clients may apply for a CRM Open Account by using the following link: http://www.crmlsi.com/wordpress/loginorder/open-new-account/
CRM Account Number*

Please enter your 5-digit CRM Account Number.
Mechanic's Lien
Price:
Mechanic's Lien
Price:
Processing Options:*
- Regular (5 biz days)
- Next Day
- Same Day
Same Day Processing must be requested before 11:00 AM (PST) to be processed the same business day. Next Day Processing must be requested before 4:00 PM (PST) to be processed the next business day.
Processing Options:*
- Regular (5 biz days)
- Next Day
- Same Day
Same Day Processing must be requested before 11:00 AM (PST) to be processed and served the same business day. Next Day Processing must be requested before 4:00 PM (PST) to be processed and served the next business day.
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$0.00
Please be aware that the total does not include the fees required for recording and additional postage. Our team will inform you of what these additional charges will be after we start processing the lien.
Online Terms & Conditions*
I Agree
I have read, understand, and will be subject to the online terms and conditions for the documents or services being requested from CRM Lien Services.
Name
This field is for validation purposes and should be left unchanged.

Claim of Lien Request

Step 1 of 7 - Select Your Notice

Select State

My Information

My Company Information

Project Information

Customer Information

Additional Information

Checkout

Place this order using my CRM Account

Services

Resources

Company