REQUEST FOR MECHANIC’S LIEN
To: RCS
Fax No.: 602-279-3789 Phone No. 602-279-7990
Please prepare a Mechanic’s Lien for the following:
Job Name____________________________________I am enclosing copies of CONTRACTS, INVOICES, PRELIMINARY NOTICES and other pertinent information.
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 $_________________
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