REQUEST TO AMEND MECHANIC’S LIEN

To: RCS Date_______________

Fax No.: 602-279-3789 Phone No. 602-279-7990

Please prepare a Mechanic’s Lien for the following:

Job Name____________________________________

Job Address__________________________________

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

As the person requesting this Amended Lien preparation, and/or release, I understand preparation of this document is a SERVICE ONLY, and that RCS assumes no responsibility or liability for the actual contents of the completed lien form and RCS shall not be responsible for errors contained in the source information. On behalf of the company, I further agree to hold RCS harmless for any claim which may arise from RCS having prepared a Mechanic’s Lien relative to this request.

Company Name________________________Phone____________

Signature & Title of person authorizing this lien request:

_______________________________ ___________________

Signature Title