Notice of Intent To Lien Request Many states require that an "Intent to Lien" be served prior to the serving of the actual Mechanic's or Construction Lien. The Intent to Lien requires most of the same preparation processes as a regular lien. The primary difference being that it is not recorded against "Title" and therefore, does not encumber the property. The Intent must be served within a very restricted timeframe and if not expedited can compromise the time to prepare, record, and serve your lien. Please review the "Processing Options" for this request and consider the Lien timeframe as you submit your Intent request to CRM. Request Name*Notice of Intent to LienPlease select the name of the notice you want CRM to prepareDate Requested* Company InformationThe following is my company information:My First Name*My Company: My First NameMy Last Name*My Company: My Last NameMy Email* My Company: Contact eMailCompany Name*My Company: NameAddress Line 1My Company: Street AddressAddress Line 2My Company: PO Box, Suite #Address Line 3My Company: Building Reference, Floor, Attn:City*My Company: CityState*Please Select StateALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYMy Company: StateZipMy Company: ZIPMain PhoneMy Company: Main Phone NumberCell PhoneMy Company: Cell Phone NumberFaxMy Company: Main FAX NumberProject InformationThe following is the project information for the Real Property being improved or to be improved and referenced in this Notice:Job Site*Job Site Name / Project IdentificationJob Reference No.Your identification for this project - Required if you want to use eGreenies or eSystems to view your served notice.Contact First NameJobsite: Contact First NameContact Last NameJobsite: Contact Last NameJob Contact Email Jobsite: Contact eMailAddress Line 1*Jobsite: Street AddressAddress Line 2Jobsite: PO Box, Suite #Address Line 3Jobsite: Building Reference, Floor, Attn:City*Jobsite: CityState*Please Select StateALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYJobsite: StateZipJobsite: ZIPPhoneJobsite: PhoneStart Date* Date you began to provide materials,labor or services to this project.End Date* Date you will finished or stopped supplying materials, labor or services to this projectDue Date* Date all amounts became dueContract Amount*The amount for which you contracted to provide materials, labor or services to this project.Contract Amount Paid*The amount you have been paid for this contractContract Amount Due*The amount you are still owed on this contractDisputed Amount*The amount you show unpaid which is being disputed.Contract Terms*A brief summary of your contract or written agreement including materials, labor, and services to be provided and your agreed terms of payment.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's: Contact First NameContact Last NameMy Customer's: 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*Please Select StateALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYMy Customer's: StateZip*My Customer's: ZIPMain Phone*My Customer's: Main Phone NumberCell PhoneMy Customer's: Cell Phone NumberFaxMy Customer's: FAXAdditional Required InformationThe following information is mandatory to process a RECORDED INTENT TO LIEN:Prelim Served?*YesNoUnknownWas a Preliminary Notice served by you on this project?CRM Served Prelim?*YesNoUnknownIf CRM did not serve your Preliminary Notice, please include a copy of your preliminary notice with this request. Please email or FAX a copy of your served Preliminary Notice to: firstname.lastname@example.org; or 714-528-0844. Thank You!CRM Document #Please include the CRM Preliminary Notice Document NumberProperty 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 Last 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: CityStatePlease Select StateALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYProperty Owner: StateZIPProperty Owner: ZIPMain PhoneProperty Owner: Main PhoneCell PhoneProperty Owner: Cell PhoneFaxProperty Owner: FAXJob CategoryPlease identify the job categoryPrivatePublicFederalOtherUnknownPlease identify your position on this project with relations to the Property Owner.Job ClassificationPlease identify the job classificationResidentialNon-ResidentialCommercialIndustrialTribal LandOtherUnknownPlease identify the classification or identification of the type of work being done.RTOPlease select your RTODirect1st Tier2nd Tier3rd Tier4th Tier or moreOtherUnknownIdentify your position to the property owner on this project.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 Number*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.Add eAlertNo eAlert (no added fee)eAlert Only (add $7.50)Managed eAlerts (add $10.00)eAlert: select to receive an email alert prior to estimated expiration of this notice. Managed eAlert: receive a monthly report on the status of all notices with the Managed eAlert option.EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.