REQUEST FOR FILING A BOND CLAIM
Legal Name of your Company
*
Claimant's Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Fax Number
E-mail
*
Contact Name and Title
*
Reference Number or PO #
Materials Sold
*
Labor Performed
*
Original Contract Amount
*
Change Orders
*
Payments
*
Amount Owed/ Claim amount
*
Last Date at Job Location
*
Payment terms
*
Owners Contract Number
Date of Contract
Project Name
*
Exact Address of Job Site
*
City, State & Zip Code
*
Contractors/Customers Name (this is the party that hired you)
*
Address
*
Is your customer the:
*
Owner
General Contractor
Sub Contractor
Surety (Bonding Company)
Surety Address
Bond Number
Principal on Bond
If your customer is not the owner or g.c., list all other parties contracted between you and the owner for proper service in the section listed Additional Parties
Name of Property Owner
*
Full Address of Property Owner
*
Additonal Parties #1
Address , City, State, Zip of Additional Party 1
Additonal Parties #2
Address, City, State, Zip of Additional Party 2
Helpful comments
I have authorized Manna & Associates, LLC and its representatives to file a bond claim on the above listed job site. I am authorized to order to this service on behalf of the above named company. We, as the claimant(s), indemnify Manna & Associates, LLC and its representatives against any ramifications that may arise from the filing of this bond claim. Manna & Associates, LLC will only be held liable for the cost of the bond claim as billed by Manna & Associates, LLC. In addition, the claimant agrees to be held responsible for all legal costs should Manna & Associates, LLC incur any as a result of a lawsuit regarding the filing of this bond claim. By clicking submit, I authorize Manna & Associates, LLC to file this bond claim on my behalf. I agree to the rates and terms as listed a www.LiensAndCollections.com.
If you would like to view our Rates and Terms,
PLEASE CLICK HERE
Name of Authorizing Individual
*
Title of Authorizing Individual
*
Check here if you would like Manna & Associates, LLC. to also perform collection on this case as per the collection rates on the rates page
Yes perform collection on this case
Once you click submit, you will be redirected and prompted to pay $425.00 through Paypal.
Bond Claim - $425.00
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