PRE-LIEN INFORMATION REQUEST FORM

 

PLEASE COMPLETE THIS FORM AND FAX OR E-MAIL BACK – ATTN:  Mimi K. (fax:  510-793-1782 / email:  mimi@osbornelumber.com).  THANK YOU FOR YOUR RESPONSE AND ASSISTANCE IN THIS MATTER.

 

JOB INFO

JOB NUMBER: ____________       

 

JOB NAME: ________________________________________________________________________________________________

 

JOB ADDRESS: _____________________________________________________________________________________________

 

CITY: _______________________________ STATE: __________________ ZIP CODE: ___________________________________

OWNER

 

OWNER’S NAME: __________________________________________________________PH #_____________________________

 

MAILING ADDRESS :________________________________________________________________________________________

 

CITY: _______________________________ STATE: __________________ ZIP CODE: ___________________________________

GENERAL CONTRACTOR

 

NAME: ____________________________________________________________________PH #____________________________

 

MAILING ADDRESS:_________________________________________________________________________________________

 

CITY: _______________________________ STATE: __________________ ZIP CODE: ___________________________________

 

LENDER

 

NAME: ___________________________________________________________________ PH #____________________________

 

ADDRESS: _________________________________________________________________________________________________

 

CITY: _______________________________ STATE: __________________ ZIP CODE: ___________________________________

Text Box: CONTACT PERSON:_________________________________________________________________________________________

OSBORNE LUMBER CUSTOMER SUPPLYING PRE-LIEN INFORMATION

 

NAME: _____________________________________________________________________________________________________

 

MAILING ADDRESS:_________________________________________________________________________________________

 

CITY: _______________________________ STATE: __________________ ZIP CODE: ___________________________________

 

THANK YOU FOR YOU HELP!  HAVE A GREAT DAY!!