Welcome to Diversified Business Solutions and Services

Use this form to request a Preliminary Lien Notice to be processed by DBS Services. DBS will research the owner, lender, and general contractor, however if you have this information, please complete that section. We will verify all information.

Allow three(3) working days after the date of receipt of this request for the Preliminary Lien Notice. If you are not a current client of DBS, you will be contacted by an account representative to review the level ofservice that you need. The request for the Preliminary Lien Notice will be processed after DBS has made contact with your company's contact person.

Your company's information:
Company Name:
Company Address:
Company Address:
Company City :
Company State:		Zip:
Company Phone:
Company Fax:
Comany Contact:
Email Address:
Do you currently have an account with DBS?	Yes

Your customer's Information:

Claimant Name:
Claimant Address:
Claimant City:
Claimant State:		Zip
Claimant Phone:
Claimant Fax:
Job Name:
Job Location:
Job City:
Job State:
Job Start Date:
Material/Service Supplied:
Estimated Dollar Amount:
Ordered By:
Contract Number:

Other Parties:

Genral Contractor:
Phone:
Address:
City:
State:		Zip

Owner Information
Owner:
Phone:
Address:
City:
State:		Zip

Lender's Information:
Lender:
Phone:
Address:
City:
State:		Zip

Genral Contractor:
Contractor:
Phone:
Address:
City:
State:		Zip

Comments:

We look forward to providing you with the higest standard of professional services.

Feel free to contact us today.

Phone:520-304-7139

Fax: 520-623-9107

Email: Mail@DBS.htmlplanet.com