.::Welcome to Lien Express::.

Legal Name of Company: *
Contact Person: *
Address: *
City: *
State: *
Zip: *
Phone: *
Fax:
E-mail: *
Name of Property Owner:
Customer or Contractor's Name: *
Name of the person with whom the contract was made: *
Address of customer or contractor: *
Labor Performed and/or Materials sold: (please specify)*
Total amount for Labor Performed and/or Materials sold: *
Total amount UNPAID to be Liened: *
First date at job location: *
Last date at job location:* (Important: For Single Family Last date must be within 4 months at job location. Multi-Family last date must be within 8 months)
Address of location to be liened: *
COUNTY of the address: *
Section:
Block:
Lot:
Name of officer signing lien: *
Terms and Agreement - I agree to allow Lien Express to act as my agent and record a lien on the property listed above. We will pay the filer of this Mechanics Lien the sum of $195USD. I, the undersigned, hereby accept full responsibility for the accuracy of the information and agree to fully imdemnify and hold harmless the filer of the lien. By entering your full name below you are authorizing this transaction and agreeing that you are the person whose name is listed on this form. A lien will not be filed unless your authorize this form by entering your full name below and the text box is checked acknowledging your understanding of the terms of this agreement.
I agree: *	Check this box to acknowledge that you read the Terms and Agreement.