Your Company's Name:
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Contact Name:
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Contact Person's Phone Number:
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Contact's Email Address
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Company Address Street 1
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Company Address Street 2
Company City
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Company Zip Code
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Your Customer (who is paying/hired you)?
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Customer's Street Address
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Customer's City
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Customer's State
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Customer's Zip Code
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Customer's Phone Number
General Contractor's Name (if the GC is your customer, just enter "same as above")
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General Contractor's Address
General Contractor's City
General Contractor's State
General Contractor's Zip Code
General Contractor's Phone Number
Bonding Company and Bond Number (if bonded and information is available)
Lender (if there is a construction loan, please include the name and address of the lender)
Property Owner's Name (if known)
Property Owner's Street Address
Property Owner's City
Property Owner's State
Property Owner's Zip Code
Job or Project Name (for example: Acme Hotel Renovations, Smith Residence New Construction)
Job Street Address (IMPORTANT: please be sure to enter the correct address)
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Job City
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Job State
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Job County
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First Day on Job or First Day Materials Provided
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Permit Number and City (if available)
If yes, please enter the book and page and county where NOC was recorded (if information is available)
Agreement Request: By transmitting this form and stating my name and title, I affirm that all information provided to The Notice Zone Inc. is accurate and complete, and I request that The Notice Zone Inc. acts as an authorized agent on my behalf to prepare and attempt to serve a Notice to Owner (NTO) based on the information furnished above. I agree to waive any and all claims against The Notice Zone Inc., for loss and/or damages that may be incurred by error or negligence committed by The Notice Zone Inc., its employees, or agents for loss and/or damages in connection to the preparation of filing this Notice to Owner (NTO). The Notice to Owner (NTO) will be prepared based upon the information provided by the customer. Any and all liability that might arise from this request will be limited to the cost of preparing and serving the Notice to Owner (NTO), and the amount shall not exceed $55.00. I am responsible for the payment of all services provided by The Notice Zone Inc. at the agreed cost of $55.00 per Notice to Owner (NTO), plus postage. Please type the name and title of the party authorizing this request. * REQUIRED
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