Submit a lien

Fill in the form below and we’ll get your paperwork started. Fields marked * are required.

1Your business

Name or business name of the lien holder.

Name *

Address *

City / State *

Zip *

Phone *

CA BAR # Bureau of Automotive Repair registration, if you have one.

2Vehicle

Make

Model

Year

Value *

Over $4,000$4,000 or less

Photos (optional)

Add photos or drag them here

Up to 4 images (JPG, PNG, GIF or BMP). Large photos are resized automatically.

3Charges & dates

Tow bill amount $

Storage per day *$

Repairs $

Date completed

Other fees $

Date in *

VIN # *17 characters.

Motorcycle engine # Motorcycles only.

4License plate & registration

License plate *

State *

Registration expiration

Month Year

5Customer information

The vehicle’s registered owner.

Name *

Address *

City / State *

Zip *

6Certification

I, the undersigned, hereby certify under penalty of perjury that I have supplied PACIFIC LIEN SALES with the names and addresses of any and all parties known by me to have an interest in the above mentioned vehicle, and all such parties are listed on this form or on the reverse side. All fees due upon signing. This lien has arisen at the time a written statement of charges for completed work or services is presented to the registered owner or 15 days after the services are completed, whichever occurs first. VIN # supplied by lien holder.

Authorization name *

Date *

Email addressOptional.

Questions? Call 1-800-752-0082

Submit a lien

Thank you! Your lien was submitted.