This legal template includes 16 fields. Request form for property owners collecting lien waivers from contractors and subcontractors. Free to customize and use on ZenBuild.
Contractor/Subcontractor Name (text, required)
Company Name (text, required)
Email (email, required)
Phone Number (text, required)
Contractor License Number (text, required)
Project Address (text, required)
Property Owner Name (text, required)
General Contractor Name (if sub) (text, optional)
Waiver Type (dropdown selection, required) — options: Conditional - Progress Payment, Unconditional - Progress Payment, Conditional - Final Payment, Unconditional - Final Payment
Payment Amount ($) (number, required)
Payment Period/Invoice Number (text, required)
Through Date (text, required)
Total Contract Amount ($) (number, optional)
Amount Remaining After This Payment ($) (number, optional)
All Subcontractors and Suppliers Paid (multiple choice, required) — options: Yes, No, N/A (no subs)
Exceptions or Disputed Amounts (long text, optional)
