Claim of Lien Request Claim of Lien A Construction/Mechanics Lien is an instrument which attaches to the title of Real Property or Secured Funds. Once recorded and notice of the recorded lien is properly served * upon the owner, the Claimant must choose to begin foreclosure or release the recorded lien within the time allowed by State Statute Some States may also allow the Claimant to extend the recorded lien beyond the statutory time allowed to perfect the lien, if specific conditions have been met. Please consult with your attorney prior to filing any Construction / Mechanics Lien. * Many States now require the "Notice of Lien" to be recorded with an affidavit of service. Please use the "Lien Type" selector to confirm the scope of your request. Note (additional fees will be added for the recordation and serving of a "Notice of Lien". Date Requested* Date of this RequestRequest For:*Please select the State and Notice TypeAL | Verified Statement of LienAK | Claim of LienAZ | Mechanics LienAR | Lien and AffidavitCA | Mechanics LienCO | Lien StatementCT | Certificate of LienDE | Consult AttorneyDC | Consult AttorneyFL | Claim of LienGA | Claim of LienHI | Consult AttorneyID | Claim of LienIL | Claim of LienIN | Intent to hold a LienIA | Verified Mechanic's LienKS | Verified Statement of LienKY | Lien StatementLA | Statement of LienME | Lien ClaimMD | Consult AttorneyMA | Statement of AccountMI | Claim of LienMN | Mechanics Lien StatementMS | Notice of Construction LienMO | Lien StatementMT | Construction LienNE | Construction LienNV | Notice of LienNH | Notice of LienNJ | Construction LienNM | Lien ClaimNY | Mechanics LienNC | Claim of LienND | Construction LienOH | Affidavit of Mechanic's LienOK | Lien StatementOR | Claim of LienPA | Claim of LienRI | Notice of Intent to LienSC | Notice of Mechanic's LienSD | Lien StatementTN | Claim of LienTX | Affidavit of LienUT | Notice of LienVT | Memorandum of LienVA | Memorandum of LienWA | Claim of LienWI | Claim for LienWV | Notice of Mechanic's LienWY | Lien StatementCanada | ClaimPlease select the appropriate State/Lien identification. For those states that require an attorney, please call 800-773-5467 before completing this request. Thank You!Lien Type*Please select the TYPE of LienOriginal Lien (Prepared for Recordation and Serving)Amended Lien (Prepared for Recordation and Serving)Extended Lien (Prepared for Recordation and Serving)Some states allow for liens to be amended or extended. Please choose the type of lien you want prepared.Add eAlert to this RequestPlease select your eAlert PreferenceeAlert Select: ($10.00)eAlert Unlimited : ($27.50)without eAlerteAlert Select: a "One Time" email alert sent prior to the expiration of your lien rights. eAlert Unlimited: a series of managed eAlerts which adjust as the project progresses. without eAlert: No eAlerts will be sentCompany InformationThe following is my company information:My First Name*My Company: My First NameMy Last Name*My Company: My Last NameMy Email* My Company: My eMailCompany Name*My Company: NameAddress Line 1*My Company: Street AddressAddress Line 2My Company: PO Box, Suite #Address Line 3My Company: Building Reference, Floor, Attn:CityMy Company: CityStateALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYMy Company: Please Select StateZipMy Company: ZIPMain PhoneMy Company: Main Phone NumberCell PhoneMy Company: Cell Phone NumberFaxMy Company: Main FAX NumberProject InformationThe following is the REAL PROPERTY which my company provided the referenced services and/or materials for which we have not been paid according to our contract:Job Site*Job Site Name / Project IdentificationJob TypePlease select the correct property ownership typePrivatePublicFederalOtherUnknownPlease identify your position on this project with relations to the Property Owner.Job ClassPlease select the correct property classificationResidentialNon-ResidentialCommercialIndustrialTribal LandOtherUnknownPlease identify the classification or identification of the type of work being done.Job RTOPlease identify your tier structure for this projectDirect1st Tier2nd Tier3rd Tier4th Tier or moreOtherUnknownIdentify your position on this project.Contact First NameJobsite: Contact First NameContact Last NameJobsite: Contact Last NameJob Reference No.Your identification for this projectAddress Line 1*Jobsite: Street AddressAddress Line 2Jobsite: PO Box, Suite #Address Line 3Jobsite: Building Reference, Floor, Attn:City*Jobsite: CityCountyThe County of the Job where the Lien must be recordedState*ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYJobsite: Please Select StateZipJobsite: ZIPJob PhoneJobsite: Job Site PhoneDescription*A brief, but comprehensive, description of the materials, labor, or services you will provide to this projectDate all invoices were due:* The date all invoices became dueContract Terms*A Summary of the proposed scope of work to be provided and the terms of payment.Contract AmountThe total amount of your Original Contract.Amount PaidThe total amount of payments you received for this contract.Adjusted Contract AmountThe total amount of your contract. Including any formally approved adds, moves, changes or adjustments.Disputed AmountThe total of the amount being disputed by either party of this contract.Lien Amount*The total of the amount being claimed in this LienInterest %Rate of interest agreed upon within our contract for this projectStart Date* Date we began working or supplying to this project.Stop Date* Date we finished working or supplying to this project.Permit Date(if required) Date the Building Permit or Notice of Commencement was issued for this project.Signer's Name:*The representative of my company who will be signing the lienSigner's Title:*The title of the representative of my company who will be signing the lien.Verification* I have read and agree to ALL terms & conditions as published on this website. I declare, that in addition to my personal knowledge and awareness of the contracts, agreements, and any other documentation regarding this claim, that the information provided in this request for Lien is both true and accurate based upon all information made available to me as an employee, officer, or associate of the referenced Claimant. In the event any information provided in this request form or should any of the information included in the Lien prepared and served by CRM Lien Services, Inc. cause or affect this lien to be declared invalid, I agree to hold harmless CRM Lien Services, Inc., it’s employees and owners.Customer InformationThe 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*Contact First NameMy Customer: Contact First NameContact Last NameMy Customer: Contact Last NameEmail* My Customer's: eMail AddressAddress Line 1*My Customer's: Street AddressAddress Line 2My Customer's: PO Box, Suite #Address Line 3My Customer's: Building Reference, Floor, Attn:City*My Customer's: CityState*ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYMy Customer's: Please Select StateZip*My Customer's: ZIPMain Phone*My Customer's: Main Phone NumberCell PhoneMy Customer's: Cell Phone NumberFaxMy Customer's: FAXGeneral Contractor InformationThe following is the General Contractor information (if the general contractor and your customer are one in the same, enter all information in the General Contract section.)Company NameName of the Direct / General Contractor for this ProjectContact First NameGeneral Contractor: Contact First NameContact Last NameGeneral Contractor: Contact Last NameEmail General or Direct Contractor: eMailAddress Line 1General or Direct Contractor: Street AddressAddress Line 2General or Direct Contractor: PO Box, Suite #Address Line 3General or Direct Contractor: Building, Floor, Attn:CityGeneral / Direct Contractor: CityStateALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYGeneral / Direct Contractor: Please Select StateZIPGeneral or Direct Contractor: ZIPMain PhoneGeneral or Direct Contractor: Main PhoneCell PhoneGeneral or Direct Contractor: Cell PhoneFaxGeneral or Direct Contractor: FAXProperty Owner InformationThe following is the Property Owner information (This information will be researched by CRM. If Known, please complete the following information about the Property Owner- This information is required for a Preliminary Notice.)Owner NameProperty Owner: Company NameContact First NameProperty Owner: Contact First NameContact Last NameProperty Owner: Contact First NameEmail Property Owner:eMailAddress Line 1Property Owner: Street AddressAddress Line 2Property Owner: PO Box, Suite #Address Line 3Property Owner: Building Reference, Floor, Attn:CityProperty Owner: CityStateALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYProperty Owner: Please Select StateZIPProperty Owner: ZIPMain PhoneProperty Owner: Main PhoneCell PhoneProperty Owner: Cell PhoneFaxProperty Owner: FAXConstruction Project Lender/Bonding Company InformationThe following is the Construction Project Lender / Bonding Company information (This information will be researched by CRM. If Known, please complete the following information about the Project Financing.)Company NameLender: Company NameContact First NameLender: Contact First NameContact Last NameLender: Contact Last NameLoan/Bond NumberConstruction Loan and/or Payment Bond InformationAddress Line 1Lender: Street AddressAddress Line 2Lender: PO Box, Suite #Address Line 3Lender: Building Reference, Floor, Attn:CityLender: CityStateALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYLender: Please Select StateZipLender: ZIPMain PhoneLender: Main PhoneCell PhoneLender: Cell PhoneFaxLender: FAXPlease include; Special Instructions, Additional Entities to be Served, or other information which you are unable to enter in other sections of this form.To capture any additional information needed for the processing of this request.Additional Required InformationPlease fill in the following information.Prelim ServedYesNoUncertainIf a prelim was not served by CRM, please FAX a copy of the served prelim to: 714-528-0844Served by CRM*YesNoUncertainPlease indicate if CRM served your preliminary notice on this project.CRM #Please provide the CRM Document Number for the served preliminary notice in the above field.Please select your payment method below.Payment Method*CRM AccountCredit CardPlease include your 5 digit account number when selecting CRM Account as your payment method. Thank You.Place this order using my CRM AccountPlease 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 No.*Please enter your 5-digit CRM Account Number.Process Via*Reg Svc (5 Business Days)Next Day RUSH (add $27.00)Same Day RUSH (add $37.00)Please select Next Day or Same Day when regular service will not satisfy the serving constraints imposed by state statute.PhoneThis field is for validation purposes and should be left unchanged.