Lien Sale Service

Your Name *

STORAGE AMOUNT PER DAY: *

Type of Tow (For Towing Companies Only):

Police Impound

Private Impound

CHP

Owner Request

Lien Holder (your company name): *

Payment Type: *

STATE:

VIN:

MODEL:

LICENSE:

address (Madatory for first time clients):

phone: *

email: *

B.A.R. License:

type of vehicle *

YEAR OF VEHICLE: *

MAKE: *

Vehicle is valued: *

TERMS AND CONDITIONS *

By submitting this form, I hereby certify under penalty of perjury under the laws of the State of California that the information entered by me on this document is true and correct and I have no information or belief that there is a valid defense to the claims which give rise to the lien. I have verified the above vehicle for correct valuation, license plate and vehicle identification numbers. I understand that filing a lien sale is for the purpose of being properly compensated for services, and never for the purpose of creating a title. Lien Sale Service will assume no responsibility for incorrect or missing information. I appoint Lien Sale Service as Power of Attorney and authorize Lien Sale Service or its employees to sign on my behalf for the purpose of a lien sale on the above vehicle. I understand that liens will not be mailed until payment is received.

INTERESTED PARTY ADDRESS:

INTERESTED PARTY (Who brought the vehicle into your shop?):

If Vehicle is valued under $4000, please describe type of damage:

Tow Bill:

Repair Bill:

Date STORAGE BEGAN: *

DATE OF POSSESSION *

MC ENGINE:

Submit a Lien Here. It's that easy.

THREE EASY WAYS TO SUBMIT A LIEN:

1. Phone: (818) 889-5826 OR (818) 402-3332

2. Fax: (818) 889-6410

3. Fill out the following form

Once we receive your order, we will send you an invoice.

*Fields marked with an asterisk are mandatory.

Submit a Lien Here. It's that easy.

Copyright Ronnie Sachs. All rights reserved.