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




To (name of contractor)

The undersigned notifies you that he or she has furnished or is furnishing (services or materials) for the improvement of the real property identified as (property description) owned by (owner’s name and address) under an order given by _____ and that the undersigned will look to the contractor’s bond for protection on the work.

(Lienor’s signature and address)


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