File a Lien - Speedy Lien, Inc.

File a Speedy Lien

Servicing New York, New Jersey and Connecticut.

File a Mechanic's Lien with Speedy Lien

We request Speedy Lien, Inc. to act as our agent in preparing, signing, and filing a Mechanic’s Lien on our behalf. We affirm that the information provided is true and correct, and we assume full responsibility in the event that any provided information is found to be incorrect. The filing fees vary by the project’s location:

New York: $475.00 (Projects in Nassau or Suffolk County: $575.00).
New Jersey: $475.00
Connecticut: $575.00

YOUR CONTACT INFORMATION

1 - Our Company's Exact Name *

2 - We Are Incorporated: *

Yes

Are you Incorporated (Inc., Corp., LLC, PLLC, etc) or a self proprietor?

3 - Address *

(A post office box is NOT a sufficient address.)

3a - City *

3b - State *

3c - Zip *

3d - Floor/Suite #

4 - Phone *

Extension

5 - Officer's Name *

5a - Officer's Title *

5b - Officer's Email Address *

5c - Cell Number *

6 - Contact Name in Your Office *

(If we have any questions, who should we speak with?)

6a - Contact's Email Address

JOBSITE INFORMATION

7 - Address of Jobsite *

7a - City *

7b -State *

7c - Floor/Suite #

7d - Store or Tenant's Name

7e - Owner's Information (if known):

7f - Section / Block / Lot / Parcel ID (if known):

8 - Labor Performed:

What type of work or service was performed? Did you perform professional services (engineering, architectural, etc.)? Hauling of Materials / Equipment to or from a jobsite. Debris removal / dumpster rental. Remediation services such as environmental, asbestos removal, etc. If you supplied materials only, please write "NONE."

9 - Materials We Used/Sold/Rented:

Did you supply materials? Did you provide rental equipment? Please provide a general list of the materials used / sold / rented. If you performed labor only, please write "NONE."

10 - Exact First Date at Jobsite (Line #7) *

(First date of a signed contract / agreement or first date services were rendered on site)

10a - Exact Last Date at Jobsite (Line #7) *

(Exact Last Date of Services Rendered / Last Date of a Delivery or Sale)

11 - Grand Total of Contract (Work Completed) or Sale (Include Extras and Taxes) *

(Grand total of services rendered to date)

11a - The Exact Amount We Are Owed *

(Including retainage, change orders / extras, etc.)

12 - Direct Customer/Client that Hired Us: *

(Who is the direct party that hired you?)

12a - Their Address: *

12b - City *

12c - State *

12d - Zip *

12e - Floor/Suite #

12f - Phone

Extension

12g - Contact Name *

12h - Email Address

13 - General Contractor

(If you were contracted directly by the property owner, client, or through the General Contractor, please list their information in #12. If you are the General Contractor, disregard #13)
Note: There is a $50 fee to serve the General Contractor.

13a - General Contractor's Name

(If you were contracted directly by the property owner, client, or through the General Contractor, please list their information in #12. If you are the General Contractor, disregard #13)

13b - General Contractor's Address:

13c - City

13d - State 13d - State

13e - Zip

13f - Floor/Suite #

13g - Phone

Extension

13h - Contact Name

13i - Email Address

14. Public Improvement - If a Public Improvement / Municipal Project (provide agency & contract #)

14a - Agency/Municipality

14b - Contract #

Additional Information

I/We agree to pay Speedy Lien, Inc. for their services and agree that services commence upon their receipt of this document. The filing fees vary by the project's location:

New York: $475.00 (Projects in Nassau or Suffolk County: $575.00).
Public Improvement Lien: $475.00 (Projects in Nassau or Suffolk County: $575.00).
New Jersey: $475.00
Connecticut: $575.00

I/We are aware that Speedy Lien, Inc. is liable to the extent of the cost of the Mechanic’s Lien in the event of error. I/We are aware that the information contained in this document is the proprietary right of Speedy Lien, Inc. and will not be sent to any other entity other than Speedy Lien, Inc. I/We are aware than any unauthorized use of this document is a violation of law and Speedy Lien, Inc. will prosecute to the fullest extent of the law.

Type Your Name as Signature *

Date *

PAYMENT INSTRUCTIONS

Paying by Credit or Debit Card, Complete the Following:

Use Credit Card on File

Yes

Cardholder's Name

Billing Address

Zip Code

Card Number

Exp Month

Exp Year

CCV #

I/We authorize Speedy Lien, Inc. to charge my/our credit card. *

Yes

If you are human, leave this field blank.

Paying By Check:

Check Payable to: Speedy Lien, Inc.

Print Intake Sheet, Prepare Check and Email Z@SpeedyLienInc.com
Or Fax: 516-679-6703

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File a Speedy Lien

Servicing New York, New Jersey and Connecticut.

File a Mechanic's Lien with Speedy Lien

YOUR CONTACT INFORMATION

JOBSITE INFORMATION

PAYMENT INSTRUCTIONS

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