True Full Name
Address
City, State, Zip
Email
Phone
Cell
Fax
BAR #
Bus Lic #
Address
2. Where Is Your Storage Facility
If the vehicle/vessel is stored at a location different from the address above, please enter the address of the storage location. If Same enter SAME.
That's It, Your Done!
Please print (ctl+p) a copy for your records before using the "Submit" button, and welcome from ASAP Accounts, We will contact you if other information is needed and and issue your ASAP account number.
Posted Storage Rate
You can change your payment options at any time, just keep us informed. If supplied, your credit card information will be kept in our files for future transactions. If the card or billing address changes, be sure to let us know so we can update the account. If you already have an ASAP account number, the number will be the same on your new account. If you do not have an account number, we will issue one on your first transaction.
Per Day
DBA/Company Name
Contact Name
True Full Name is required on all lien documents. Last, First, Middle.
Have questions before you submit this application? Give us a call 510-799-2667
1. General Information
When paying by credit card, the billing information should be exactly as it appears on your credit card statement. For credit card verification, please ensure that your first and last name are entered as they appear on your card.
By clicking the "Submit" button below, you confirm that you have read and agree to the terms and conditions set forth above.
Name As It Appears On The Card
Zip Code Where Your Credit Card Statement Is Mailed
Expiration Date
Card Number
Type Of card
Security Code On The Back Of The Card
3. Payment Options
To Fax, Print (Ctl+P) This Page And Fax To (510) 799-1456
When you submit this form to ASAP Lien Sales, signed or not, it is a binding contract. This form authorizes a lien to be processed by ASAP Lien Sales with the information you provide, and that you will hold ASAP Lien Sales harmless from any lawsuits, judgments, omissions or errors of any kind and under any circumstances. This agreement shall extent to all prior and future liens processed by ASAP Lien Sales.
This form authorizes ASAP Lien Sales to bill you as indicated above for services performed. Statements will be sent on the 26th of each month and are due on the 10th of the next month and late on the 15th. If however, you do not receive a statement for whatever reason, all payments are due on the 10th of each month following that billing cycle.
I certify under penalty of perjury under the laws of the State of California, that the information I have provided is true and correct.
Sign X
Type Name
Date
New Account Application
City, State, Zip
4. Terms/Agreement
Thank You For Choosing ASAP Lien Sales
Please Note: You can print (ctl+p) this page and mail or fax this form
Print (ctl+p) and Fax To 510-799-1456 or use Submit button below
Print (ctl+p) and Fax To 510-799-1456 or use Submit button below
