Lien or Bond Claimant Information (Who Are You?)
Your Company’s Exact Corporate Name
State of Incorporation
Your Status in the Project
Do You Have a Written Contract?
Do You Have a Notice of Commencement and/or Payment Bond? (
If yes, please fax a copy to
(248) 851-1094, Attn: Ronald B. Rich,
or email it to email@example.com
Entity With Whom You Contracted (enter details below)
Contract Amount (including extras)
Amount Currently Due on the Contract
Material and Labor Information - Did You Provide:
Both Labor and Materials
Description of Materials and/or Services Provided:
First date of providing labor or materials to the job:
Last date of providing labor or materials to the job:
Project Information - Job Site Name:
Legal description of property:
See attached legal description.
Subcontractor (if applicable):
Please Provide Me (What Do You Want?)
Notice of Furnishing
Before submitting the form, please review and verify all information is correct. Ronald B. Rich & Associates is not liable for misinformation.