Lien Submission Form

Use this form below so we can start your lien today! Once completed, one of our representatives will contact you.

Note: if you have already submitted this form and just need to make a payment to us, please visit our payment options.

By submitting this form, I hereby certify under penalty of perjury 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. Independent Lien Service will assume no responsibility for illegible or missing information. I appoint Independent Lien Service as Power of Attorney and authorize Independent Lien Service or its employees to sign on my behalf for the purpose of a lien sale on the below vehicle.

Company Information
gastropod
Vehicle/Vessel Information
Is the Vehicle/Vessel in your possession?
Vehicle Value:
Vessel Value:
gastropod
Other Information

Note: The Yellow boxes are required fields and must be completed.
If you have already submitted this form and just need to make a payment to us, please visit our payment options.

gastropod

Thank You,
The Independent Lien Service Department

Independent Lien Service
415-706-6344 voice line
707-774-6469 fax line