File a Unpaid Broker's Commission Lien

Unpaid Broker's Commission Lien

We request Speedy Lien, Inc. to prepare and file a Unpaid Broker’s Commission Mechanic’s Lien on our behalf as our agent. The information we provided is true and correct and we assume responsibility in the event information provided is incorrect. The filing fee is $675.00

YOUR CONTACT INFORMATION

1 - Our Company / Brokerage Name: *

2 - Our Address *

2a - Floor/Suite #

2b - City *

2c - State *

2d - Zip *

3 - Phone *

4 - Email Address: *

5 - Officer of the Firm or Salesperson *

5a - License #:

UNIT INFORMATION

6 - Address of Leased Property *

6a - City *

6b - State *

7 - Tenant:

8 - Lease Type

(Commercial Office, Retail, Industrial, Etc.)

9 - Lease Term / Length of Lease: *

10 - Date Lease was Signed:

10a - Date Commission was Due:

11 - Amount Owed: *

12 - Landlord

12a - Landlord's Address

12b - Floor or Suite:

12c - City

12d - State *

12e - Zip

13 - Landlord Contact:

13a - Their Email:

14 - Do You Have a Signed Agreement?

YES

I/We agree to pay Speedy Lien Inc. $675.00 for their services and agree that services commence upon their receipt of this document. 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 information contained in this document is the proprietary right of Speedy Lien Inc. and will not be sent to any entity other than Speedy Lien Inc. I/We are aware that 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:

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.

If Paying By Check:

Check Payable to: Speedy Lien, Inc. Print Satisfaction Request, Prepare Check and Email DN@SpeedyLienInc.com

Or Fax: 516-679-6703

File a Unpaid Broker’s Commission Lien

Unpaid Broker's Commission Lien

We request Speedy Lien, Inc. to prepare and file a Unpaid Broker’s Commission Mechanic’s Lien on our behalf as our agent. The information we provided is true and correct and we assume responsibility in the event information provided is incorrect. The filing fee is $675.00

YOUR CONTACT INFORMATION

UNIT INFORMATION

PAYMENT INSTRUCTIONS

If Paying By Check:

Industry Leader

We Service

Your Lien is Filed

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Contacts

Where we File

What we File