Mechanics Lien - Arizona

Forms received by Caprenos before 1:30 PM will be considered received that business day. Forms received after 1:30 PM will be considered received the following business day.

Job Address(Required)

Street Address Address Line 2 City State ZIP Code

The Amount Due After Deducting All Just Credits and Offsets is: $(Required)

Plus Interest Starting From This Date:(Required)

At the Percentage Rate of (%)(Required)

I Furnished(Required)

(Type of Materials or Service)

At the Request of(Required)

(Your Customers Name or Company)

Your Customers or Company Address

Street Address Address Line 2 City State ZIP Code

Please check one of the following and attach copies of invoices and contracts.

The Labor, Materials, Machinery, Fixtures or Tools Were Furnishing Pursuant to:(Required)

A written contract (I have attached a copy).

An oral contract (the terms, time given and conditions should be submitted with this request).

Invoices for materials shipped or services billed are attached.

File

Max. file size: 256 MB.

Attention:

If Caprenos prepared a Preliminary Notice for you on this job site, please note the number of this notice here:

Prelim Number

Log#

If a Preliminary Notice was prepared by you or someone else for the above jobsite, please be sure to attach a copy to this request. Be sure your notice copy has the proof of service completed and notarized as this Preliminary Notice (when required) must be attached to your lien for recordation.

Date of First Shipment of Materials or Services to the Jobsite Was:

Date you finished the job:

Completion date of entire job:

Your prepared form will be mailed back to you for your signing. It will come to you in the form of a total package with no guesswork in it for you. You will be instructed to sign each copy and which envelope to place each copy into. All envelopes will be addressed and posted for your convenience. You will also receive a check list for the lien package. This check list will help you with the follow through as to what you should do after your lien is formally recorded.

I understand that the preparation of the Mechanics Lien Form is a service only. Caprenos Inc. assumes no responsibility or liability for the actual recording or the contents of the completed Mechanics Lien Form.

I Am the _____ of the Company Noted Below:(Required)

Owner

President

Manager

Your Company's Full Name(Required)

Phone(Required)

Address(Required)

Street Address City State ZIP Code

Note: All requests for Lien Form Preparation must be prepaid. $350.00 for 5-7 working days or $450.00 for 2-day service. Recording fees will be added for liens we record on your behalf. Thank You.

Signature(Required)

Title

Date