REQUEST FOR MECHANIC'S LIEN / CONSTRUCTION LIEN
(A) Lienors Information
Todays Date
*
Legal Name of Your Company (Lienor)
*
Phone Number
*
Fax Number
Contact Name
*
Physical Address
*
No PO Boxes
City
*
State
*
Zip
*
E-mail address
*
(B) Complete this section with your customers information
Name of Company by whom the Lienor was employed or to whom he furnished materials to or with whom the contract was made
*
This is the company that hired the Lienor
Phone Number
*
Fax Number
*
Contact Name
*
Customers Business Address
*
City
*
State
*
Zip
*
(C) Jobsite Location
Jobsite Address
*
City
*
State
*
Zip
*
Job Name if available
Contract Date (NJ Only)
Contract number (Public Jobs Only)
Payment terms- (Public Jobs Only, EX 30 days)
If the jobsite is a public job, state public agency in section (H)
(D) Complete this section based on the jobsite location.
Supply documentation showing the source of the section, block, lot information, otherwise, it may be listed as on the most recent record available. We cannot guarantee the search results. If the jobsite you are liening is in NJ, the law requires that all work be agreed to in writing. You will not be asked to supply a written contract or written change orders to our office at the time of your lien filing unless you worked on a one, two or three family home or condominium.
Property Type (Office Bldg, Single Family, Condo, Church, School)
Section
Block
Lot
(E) Complete this section based on your companys status on the project
Is YOUR company the
*
Please Select
General Contractor
Subcontractor
Supplier
Architect/Engineer
Other
If OTHER please indicate
(F) Complete this section based on the Lienors Labor and Material
(F1) Labor actually performed. Be specific- DO NOT include labor you did not perform
*
If no labor performed then put NONE
First Date Labor Performed
*
If no labor performed then put NONE
Last Date Labor Performed
*
If no labor performed then put NONE
(F2) Material actually furnished. Be specific- DO NOT include materials in your possession
*
If no material furnished then put NONE
First Date Materials Furnished
*
If no material furnished then put NONE
Last Date Materials Furnished
*
If no material furnished then put NONE
(F3) Materials Actually Manufactured specifically for this job, but not delivered
*
If no custom Materials are being held by you then put NONE
(G) Complete this section based on the Contract
(a) Contract Amount
*
(b) Change Orders
*
If question does not apply, put 0
(c) Value of Custom Materials Manufactured still in your possession - You can lien for these items
*
If question does not apply, put 0
(d) Value of unfinished portion on the contract - Do not include value of Line (c)
*
Do not include custom material manufactured still in your possession already entered above
(e) Backcharges
*
This is any additional deduction from your contract
(f) Total Payments
*
Amount to be liened a+b-d-e-f
*
If your number do not add up, please call us to discuss your lien
(H) Complete this section if you have additional parties to be served.
If your customer is not the Owner, complete this section with all parties between you and the Owner to perfect service (G.C., Tenants, etc.). Supply documentation showing the source of the owner's information, otherwise, the owner may be listed as on the most recent record available. We cannot guarantee the search results.
Name of Property Owner
Address of the Property Owner
Additional Party #1
Party #1 Address
Additional Party #2
Party #2 Address
(I) Complete this section based on your customers status on the project
Is your customer the (Check one)
Please Select
Owner
General Contractor
Subcontractor
Other
If OTHER please indicate
Would you like Manna and Associates LLC to perform collection services on this debtor?
*
Yes, I would like Manna and Associates, LLC to perform collection services. By checking YES, I agree to pay a percentage of what is collected based on the rates and terms listed at www.LiensAndCollections.com
No I would not like Manna and Associates, LLC to perform collection services at this time. I just want my lien filed.
I am unsure and would like more information before making this decision.
Comment
Authorization
I am authorized to sign on behalf of the lienor. I, the lienor, have authorized Manna and Associates, LLC ("Manna") and its representatives to sign as our agent on these documents pertaining to this property. I understand that I, the lienor, signing below am the actual filer of the Mechanic's Lien / Construction Lien and am the party responsible for sending such documents in for filing. By clicking the "SUBMIT FORM" button, I jointly and severally, agree to the terms, conditions and prices listed on www.LiensAndCollections.com. The lienor understands that "Manna" is not a law firm and information provided is not legal advice. I / We as Lienors indemnify "Manna" and its representatives/employees against any ramification that may arise from the filing of this lien. "Manna" will only be held liable for the cost of the Mechanic's Lien / Construction Lien as billed by "Manna". In addition the Lienor agrees to be held responsible for all legal costs should "Manna" or its employees / representatives incur any, as a result of a lawsuit, regarding the filing of this lien. The Lienor understands that any items missing or left blank may cause the lien to be incorrectly filed. All information provided in Section A through J on this form is agreed to and is true and factual based on the books and records of the lienor.
If you would like to view our Rates and Terms,
PLEASE CLICK HERE
Name of Individual Authorizing Lien
*
Title
*
Select a service. Once you submit, you will be redirected and prompted to pay through Paypal.
If you do not complete the paypal process, your lien will be held pending the receipt of the filing fee.
My Services - Prices subject to change.
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( X )
Due within 21 Days
$48.00
$
48.00
Includes 2 way overnight charge. Select this + Lien
Liens in New York (Manhattan, Brooklyn, Queens, Bronx, Staten Island and Westchester.)
$425.00
$
425.00
Liens in Nassau (First Block Only)
$650.00
$
650.00
Liens in Suffolk County (First Lot Only)
$550.00
$
550.00
Public Liens (NY or NJ)
$475.00
$
475.00
NJ Construction Liens - (Commercial)
$475.00
$
475.00
NJ Notice of Unpaid Balance (1,2,3 Family, Condos or Cooperatives) and Arbitration filing - this fee includes arbitration through mail only, construction lien fee not included.
$900.00
$
900.00
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