Project Information

Job site name:
Street Address:
City:
State:
Zip-Code:
Owner:
Street Address:
City:
State:
Zip-Code:
General Contractor:
Street Address:
City:
State:
Zip-Code:
Sub-Contractor:
Street Address:
City:
State:
Zip-Code:

If the job is bonded? If yes please e-mail bond to blandel@commercialcollection.com or fax to 800-873-5211.

If you have notice of commencement, please e-mail to blandel@commercialcollection.com or fax to 800-873-5211. (if applicable)

If the lien waiver is asked for, please e-mail to blandel@commercialcollection.com or fax to 800-873-5211. (if applicable)

Sales Information

Project manager name:
First delivery date:
Last delivery date:

Action To Be Taken
(choose all that apply)

File lien (fax or e-mail invoices/statements)
Send pre-lien Notice
Obtain copy of bond and verify coverage
Investigate lien potential
File bond claim

Additional Comments

If you have any questions at all, do not hesitate to call Bob Landel at 800-873-5212 ext 256 or e-mail blandel@commercialcollection.com.

Disclaimer of Liability

It is understood and agreed that CCC of New York wil use its best efforts to serve or file the above requested document and that CCC of NY is providing its services through sources it deems to be reliable. CCC of NY shall not be responsible or liable for claims for damages for any reason whatsoever, including claims for special, punitive, incidental or consequential damages, or claims for lost profit.