Translator

Lien Submission

Name or Business Name
Name
Address
City/State Zip
Phone
CA BAR #

 

Make
Model
Year
Value  $4000+ $4000-
Upload Images (optional)

 

Tow Bill Amount
Repairs Date Completed
Storage per Day
Other fees
Date in
VIN #
Motorcycle Engine #
License Plate State
Reg. Exp. Date Month Year

 


Customer Information
Name
Address
City/State Zip

I , The undersigned, hereby certify under penalty of perjury, that I have supplied PACIFIC LIEN SALES, with the names and addresses of any and all parties known by me to have an interest in the above mentioned vehicle and all such parties are listed on this form, or on the reverse side. All fees due upon signing. This lien has arisen at the time a written statement of charges for completed work or services is presented to the registered owner or 15 days after the services are completed, whichever occurrs first. VIN # supplied by lien holder.

Authorization Name   Date
Email Address