Contractor Lien Waiver Form printable pdf download

Contractor Lien Waiver Form

Date:

_______________________

County:

_______________________

State:

_______________________

Customer Name:

________________________________________

Customer Phone:

________________________________________

Customer Address:

_______________________________________________________________

Job Address:

_______________________________________________________________

Contractor Name:

________________________________________

Contractor Address:

_______________________________________________________________

Contractor Phone:

________________________________________

Payments Rec’d To Date:

$ _______________________________

Payment Received TODAY:

$ _______________________________

(Lien release is contingent on the contractor receiving this payment)

The Contractor signing below acknowledges receipt of all payments stated above. These payments are in compliance with the written

contract between the parties above. The Contractor signing below hereby states payments for all work done to this date has been paid

in full.

The Contractor signing below releases and relinquishes any and all rights available to place a mechanics or material man lien against

the subject property for the above described work. All parties agree that all work performed to date has been paid for in full and in

compliance with their written agreement.

The undersigned Contractor releases the Customer for any liability from non‐payment of material or services extended through this date.

The undersigned contractor has read this entire agreement and understands the agreement.

Contractor:

Date:

_____________________________________

__________________________

Contractor Lien Waiver Form