Fill and Sign the General Liens Form

Questionnaire Regarding Liens Client Information Legal name of company claiming the lien:       Company formation: Sole Proprietorship Partnership Corporation State of incorporation:       Current address:       County where office located:       Contact person and telephone number:       Who will sign the lien (preferably an owner, partner or officer of the corporation)?:       Title:       Contract Information Name of owner of the property:       Street:       City:       State:       Zip:       Current property owner(s) address if different: Type of contract:       Original Contract Amount: $       Extras: $       Amount(s) Paid to Date: $       Payment plan:       Waivers:       Please attach copies of any Agreements, Contracts, Invoices, Change Orders, Lien Waivers, Pre-Lien Notice and any other information that may be helpful. Have any notices been sent? Yes No If yes, please list notice type and date sent:                               Have you attempted to work out a payment plan? Yes No If yes, please describe:       Other agency involved, if applicable:       Other claimants involved, if applicable:       Legal description of property lien is sought on:       County where property is located:       Street address of the property, if applicable:       Dollar amount of claim (list interest or finance charges separately and do not include any amounts for work not yet performed):       First date service performed (including delivery of equipment and materials):       Last date service performed (not including warranty work):       Name and employer of person that hired you:       Address:       Telephone:       Name(s) of any bank(s) financing the services, if known:             Storage costs to date, if applicable: