How to fill out this form.
  1. This form must be completed and signed by each contractor you use.
  2. The dollar amount on this form must match the dollar amount on the contractor’s contract.
  3. As the borrower, complete and sign the bottom portion of each form.
  4. Return all completed original forms to us.
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CONTRACTOR'S WAIVER OF LIEN

Loan Number:

If you are working with multiple contractors, each one must complete this form.
To avoid delays please complete this form in its entierety before submitting it.

Claim Number:

Borrower Name:


Co-borrower Name:


Borrower Address:


City, State Zip:







Contractor Declaration:

 

Conditional upon payment of $, all claims(s) of lien for labor and/or materials will be waived

(must match dollar amount on contractor's contract).

I, the undersigned contractor, hereby declare that I am duly licensed under applicable laws and regulations, all liens will be waived upon payment as noted, I am qualified and experienced to perform the type of work contracted, financially able to complete the repair or reconstruction within scheduled time frames, will comply with applicable codes and regulations governing residential repair or reconstruction (including, but not limited to, building codes and zoning, permit and inspection regulations), and I will be repairing damage at the property listed above as reported in the insurance adjuster's report unless specifically noted.



****Do not fill out the Bond information if you are submitting a copy of your license*****
Name of Surety Company Issuing Bond: _______________________________________
Surety Bond Number: _________________________
Amount of Surety Bond: $________________________________________________

Borrower to complete:     (By signing below, you indicate that you agree with the above information.)




 

Once you and your contractor(s) have completed this form please return it to us by mail or fax to: 


Regular Mail:

Overnight mail:

Fax:

Attn: Loss Draft Department