Lien Research - place an order

If you are submitting a LIEN or CLAIM request we must have a signature. Therefore, Please complete the order form, sign & fax to: (425) 252-2754.

Date:		L.R.C. Order#:
Your Name:		Your Customer:
Company:		Address:
Phone:		City, State:	,
Email:		Zip:
Type of Order:
Previous LRC # (if any)		Your Invoice # (if any)

Project Name:		1st Date on Job:
Job Site Address:		Last Date on Job
City:		Amt of Lien/Claim
State		Total Amt. of Lien
Zip

LABOR/MATERIALS DELIVERED:
Owner Name:		General Contractor Name:
Owner Address:		G.C. Address
City:		G.C. City
State:		G.C. State
Zip:		G.C. Zip

Lender Name:
Lender Address:
Lender City, State:	,
Lender Zip:

FOR LIENS AND CLAIMS ONLY -
I have read the forgoing claim. Read & know the constraints thereof and believe the same to be true and correct & that the claim of lien is not frivolous and is made with reasonable cause and is not clearly excessive under penalty of perjury.

X signed________________________________________________________

© 2000 - 2007 Lien Research Corp.
P.O. BOX 148, Marysville, WA 98270
Toll-Free: 800-446-4978
Phone: 425-252-6641
425.252.6641 Fax:425.252.2754 Email: info@lienresearch.com

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