MECHANIC’S LIEN REQUEST FORM

Telephone: 619-460-9020 -  Fax 619-460-9025

*   Indicates Required Fields

Please check your fax machine for confirmation the morning following the process of your Mechanic's Lien Request.  If you do not receive a confirmation, please contact MASTER LIENS immediately.

Company Name:   *

Your Name: * 

Your Company Telephone No.:  *

First and Last Dates that YOU provided Materials, Labor and/or Services to the Project:
First Date:     *          Last Date:  *

Total Contract Value  (including change orders) of Labor, Materials and/or Services to be furnished to the Project: 
$    * 

Amount Paid to your Company:  $   * 

Outstanding Balance Owed to your Company:  $   *

Interest rate against project owner:    %
(Legal Rate For Mechanic’s Liens is 10%) 
Your contract may provide for a different rate that you may collect from your customer.

When did Interest begin?: * (Date)

What are the Terms of your Contract or Invoices? *

   *

Your Customer Or The Party That You Contracted With:  *

Customer or Party’s Address:  

General Contractors Name:      *

Contractor Address: 

Owners Name:       *

Owner Address: 

Project Name:

Address: