Name of Lienor:

Street Address of Lienor:

Suite/Apt (if applicable):

City:

State (2 letter abbreviation):

Zip Code:

Phone (Format: xxx-xxx-xxxx):

Fax (Format: xxx-xxx-xxxx):

E-Mail Address :

Contact Person: (if different from above please enter your contact details including Name, Mailing Address, Phone and E-mail.)

LIEN INFORMATION
 

Name and Address of the contractor you provided work and/or materials for the Project.

What is your relationship to this project?

If your answer to the question above is subcontractor, please supply the name and the address of the contractor.  If your answer to the question above is sub-subcontractor, enter the names and addresses of both contractor and subcontractor:

Was the work done pursuant to a written contract, purchase order, exchange of written correspondence, or delivery tickets?

Date of Contract (format mm/dd/yyyy):

Describe materials you furnished and work you performed on the project.

Last Date you provided Labor and/or Materials
(format mm/dd/yyyy):

Date of overall project completion (this date is important to determine whether your lien can be timely filed):
(format mm/dd/yyyy):

Name of Project (i.e. school name, park name etc.):

Name and address of the public entity for whom the project is being performed (if known):

Name of company that has a contract with the Owner

Exact address of jobsite:

Is this a city, county, school or government job?

Is the owner of the job the State, a State College or a State agency?

Name and Address of the person/company with whom you have the contract:

Contract Amount:

Payments Made to You:

Total amount still owed to you for work and/or materials provided to the Project:

Name and title of duly authorized company officer entitled to sign lien:

DO YOU AUTHORIZE NJLIEN.COM TO ACT AS YOUR AGENT TO FILE THE LIEN?           

  Choose from this menu Yes

This purchase is non-refundable. By choosing yes in the field to the right and pressing submit below, you agree that NJLien.com’s liability is limited. The filing of a lien is not a guarantee of payment. In the event it becomes necessary to negotiate a settlement or commence litigation to collect your money, you may want to speak with an attorney. NJLien.com works closely with attorneys with substantial experience in construction law and lien foreclosure actions. If you would like to speak to an attorney, please contact NJLien.com at 1-888-LiensNJ (1-888-543-6765).  Please read the Legal Disclaimer associated with this site. Clicking on the link will open an popup window you will not lose your work.

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