Construction Lien Claim


Construction Lien Claim Request Form
 Your Company Name :
 Contact :
 Telephone :
 Fax :
 File A Lien Against (The contractor/person that hired you)? :
 Job Site Address :
 Customer Telephone :
 Customer Contact :
 Would you like RoHillCo to contact customer as a courtesy prior to filing?        
 Would you like us to contact the Homeowner as a courtesy before the filing?  
 Is this project residential or commercial?  
 Did you supply labor, materials or both?  
 When did you commence supply or service? 
 What was you last day of supply or service?  
 What was the total amount of the contract/job?      Labor :   Material :
 Payments received?           Principal balance owing? 
 Finance charge owing?      Through what date?
 Was a notice of right to lien sent (include copy)? 
 Full name and title of document signer (must be knowledgeable of circumstances of the debt):
RoHillCo Business Solutions, LLC
5 Mount Jefferson Terrace
Lake Oswego, OR 97035
503-636-0495  Fax 503-636-0848