Arizona National Lien and Bond Co., LLC

Payment Demand Letter Request Form

A payment demand letter is your last effort to collect on your outstanding receivable before assigning to our recovery department. Please complete the form below and we will send out a formal demand letter on your behalf.

By submitting the following request, you understand:

If you do not receive payment within 20 days of our office sending out the formal demand letter, this account will be assigned to our recovery department.

There will be no charge for the demand letter if assigned to our recovery department.

If you are paid off the demand letter, and this account is not assigned to our recovery department, there is a $50 plus postage fee

Your Company Information

Your Company Name (Required)

Your Company Address

Your Company City,
State, Zip , ,

Your Company Phone & Fax ,

Your Company
Email Address (Required)

Your Company
Contact Person (Required)

Customer Information

Customer Name (Required)

Customer Address (Required)

Customer City, State, Zip , , (Required)

Customer Phone & Fax , (Required)

Customer Contact Person (Required)

Amount Due (Required)

Due Date

(Required)

Property Information

Property Owner Name (Required)

Property Owner Address (Required)

Property Owner
City, State, Zip , , (Required)

Property Owner Phone & Fax , (Required)

Lien Information

Date of Preliminary Notice

Date Lien was Filed

(Required)

State Lien was Filed in (Required)

Amount of Lien (Required)

Name of company preparing lien
(If other than Arizona National Lien and Bond Co.)

Additional Information

Comments