Claims

Claim

The form below is used to submit Claims to Lien Research. Please do not print this page. Once you click Next at the bottom of this page, you will be taken to the page requiring your signature. To download a PDF of your submitted order, go to the My Documents page and click "Download and Print Order".

RUSH ORDER option*
- RUSH ORDER
- NOT A RUSH ORDER
Any service that needs to be performed within 3 business days should be marked as a RUSH order

By selecting RUSH ORDER while submitting your order, you acknowledge that you will be charged a RUSH fee. Lien Research Corp will not be responsible for orders placed with less than 3 business days to complete following legal requirements. Subscriber assumes full responsibility for RUSH jobs. Please call 800-446-4978 with any questions about this service.
- Your Name*
  First Last
- Company*
- Company OLD
- Phone*
- Email*
- This field is hidden when viewing the form
  Type of Order*
- Previous LRC# (if any)
- Invoice# (if any)
- Project Name*
- Job Site Address*
- City*
- State*
- Postal Code*
- Brief Description of Labor/Materials Delivered
- Owner's Name
- Owner's Address
- City
- State
- Zip Code
- Lender's Name
- Lender's Address
- City
- State
- LRC Order#
- Zip Code
- Who Hired You?*
- Who Hired You Address*
- City*
- State*
- Zip Code*
- - Customer is same as General Contractor
- First Date on Job*
  MM slash DD slash YYYY
- Last Date on Job*
  MM slash DD slash YYYY
- Estimated/Contract Amt
- Payments/Credits to Date
- Principal Amt Owed/Lien Amt*
- General Contractor Name*
- General Contractor Name*
- General Contractor Address*
- City*
- State*
- Zip Code*
- General Contractor Address*
- City*
- State*
- Zip Code*
- Comments
- Need to upload additional file?
  - Yes
- File Upload
  Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 8 MB.
- This field is hidden when viewing the form
  Form Tracker
Sworn statement of claimant or claimant's authorized representative

I hereby state and represent that I have requested the forgoing claim, that I have read and know all of the contents thereof, and I believe the same to be true and just and not frivolous, under penalty of perjury
SIGNATURE (REQUIRED):*

Claims

Claim

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