NOTICE OF RETURNED CHECK

RETURNED CHECK

Screen Shot 2021-05-06 at 5.45.23 PM.png

LIEN UTAH LLC

P.O. Box 171053
Salt Lake City, Utah 84117
801-272-0912 (o)
801-273-1061 (f)
order@lienutah.com

ORDER FORM – NOTICE OF RETURNED CHECK

(Used to Notify the Issuer of a Check that the Check was Returned by the Bank)

IDENTIFY EACH PERSON WHO MADE, DREW, SIGNED, OR ISSUED THE RETURNED CHECK:

Issuer 1:

Issuer 2:

Issuer 3:

PROVIDE THE FOLLOWING INFORMATION ABOUT THE RETURNED CHECK:

IDENTIFY THE HOLDER OF THE CHECK (I.E. THE PERSON OR COMPANY BEING PAID BY THE CHECK):

SPECIAL INSTRUCTIONS:

SIGNATURE & TERMS: The holder of the returned check(s) on whose behalf this form is submitted (“Customer”) hereby appoints Lien Utah LLC as its agent for the limited purpose of preparing and serving the notice requested herein. Customer warrants that it is the holder of the returned check(s) referenced herein and that the information provided herein is true and accurate. Customer covenants to indemnify, defend (with counsel chosen by Lien Utah LLC), and hold harmless Lien Utah LLC, and its agents, successors and assigns, against any and all claims brought against Lien Utah LLC arising from the notice requested herein. Customer understands and agrees that Customer’s sole and exclusive remedy against Lien Utah LLC for any damages, including direct, indirect, or consequential damages, arising from the notice requested herein is limited to a refund of the amount paid to Lien Utah LLC for the services requested by Customer in this order form. If Lien Utah LLC is asked to provide trial or deposition testimony, sworn declarations, or other evidence, it will be paid $40 per hour for the time incurred. The undersigned warrants that he/she is duly authorized to order this notice on behalf of Customer and does so with its authorization. Customer agrees to promptly pay for the requested services upon receipt of an invoice. If payment is not made within 21 days of the invoice date, Customer will pay interest at the rate of 2% per month from the invoice date on all amounts owed. Customer will pay Lien Utah LLC’s attorneys’ fees and costs incurred in enforcing these terms.    Price assumes one check per notice.  $15 will be charged for each additional bounced check included in the same notice and for each additional address to which the notice is mailed.  Price assumes customer will provide complete and accurate information.  If not, an additional charge will be assessed commensurate with the time needed to obtain the missing information

Signature (a typed signature functions as a written signature).

Thanks for submitting!