Lewis Lien Sales
An Auto Lien Sale Processing Service Company
Auto Lien Submission Form
LIEN INFORMATION

Use this form below to have one of our representatives contact you. We can start your lien today!

By submitting this form, I hereby certify under penalty of perjury under the laws of the State of California that the information entered by me on this document is true and correct and I have no information or belief that there is a valid defense to the claims  which give rise to the lien(s).  I have verified the below vehicle for correct valuation, license plate and vehicle identification numbers. Lewis Lien Sales will assume no responsibility for illegible or missing information. I appoint Lewis Lien Sales as Power of Attorney and authorize Lewis Lien Sales or its employees to sign on my behalf for the purpose of a lien sale on the below vehicle.
First Name:
Last Name:
Company Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
Vehicle/Vessel Information:
VIN or Hull Number:
Is the Vehicle/Vessell in your possession?:
Date of Possession:
License Plate or CF Number:
Make:
Model:
Year:
Motorcycle Engine Number:
Repair Shop Bar Number (Required if charging repairs.):
Repair Amount:
Daily Storage Charge:
 Vehicle Value: Under $4000      
  Over $4000
 Vessel Value: Under $1500
  Over $1500
How did you hear about us?:
Please enter your full name for authorization of this lien sale submission. This will act as your signature.
Comments:



Copyright . Lewis Lien Sales. All rights reserved.