(Consult an attorney before using this form or relying on this information)




To (name of contractor and address)

(name of surety and address)

The undersigned notifies you that he or she has furnished (describe labor, services, or materials) for the improvement of the real property identified as (property description) . The amount now due and unpaid is $_____.

(signature and address of lienor)


Watch This Video on How to File a Payment Bond Claim in 3 Simple Steps; Notice to Contractor, Nonpayment and Lawsuit [VIDEO]