REQUEST FOR 90 DAY BOND NOTICE

To: RCS Date_______________

Fax No.: 602-279-3789

Please file a bond claim on the following:

Job Name____________________________________

Job Address__________________________________

Is the project being built in phases?________________

The date of the first shipment of materials or labor supplied was__________

The date of the last shipment of materials or labor supplied______________

The exact dollar amount that is due on this project is $_________________

I am enclosing a copy of the Preliminary Notice.

Your Company Name_______________________Phone _____________

Signature & Title of person authorizing this lien request:

_______________________________ ___________________

Signature Title