Construction Notice Registration Form
All the fields marked with an asterisk(*) must be filled out to register.
*Company Name
*Contact Name
*Address1
Address2
*City *State *Zip
*Phone
*Fax
*E-mail - Your password will be sent to this email address. Please make sure you have access to this email account!
Product/Service Provided to Customer
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Checking this box will authorize, empower and direct and request that you, as my/our agent, shall execute in my/our
stead any and all notices pursuant to Chapters 718 and 255 of the Florida Statue, from the date of receipt by you of
this letter until said authority is terminated in writing. I/we shall furnish to you a written request on your form
containing the necessary information to properly complete and serve said notices as soon as practicable for each
job for which I/we request that you send said notices.
The registered member shall from time to time request CONSTRUCTION NOTICE, Inc. to prepare and attempt to serve a
Notice to Owner and/or Notice to Contractor (“Notices”) and Liens, based upon the information that is furnished to it
on the “Request for Notice to Owner” or Lien form and research you may perform. I hereby agree on behalf of myself and
my firm to pay any research, preparation and serving expenses generated by my request or my representatives upon receipt
of the invoice. In the event that payment is not made within 30 days of the date of the invoice, I agree to pay
interest of 18% per year as well as all costs of collections, including reasonable attorney fees. We understand and
agree that in requesting these notices and/or liens we waive and relinquish any and all claims or rights we may
have against CONSTRUCTION NOTICE, Inc. based upon its action or that of its officers, employees or agents, for damages
and/or losses we may sustain by virtue of any act, negligence, mistake or deviation in the performances of these
services, including, but not limited to, researching, preparing and serving the notices on our behalf. In waiving our
right to claim damages as set forth above, we agree that the sole remedy for CONSTRUCTION NOTICE Inc.’s failure to
properly or timely serve a notice/lien for us shall be for CONSTRUCTION NOTICE, Inc. to refund to us or otherwise credit
our account for any charges or fees assessed against us by CONSTRUCTION NOTICE, Inc. based upon the serving or attempted
serving of said Notice to Owner. In any event, at no time shall CONSTRUCTION NOTICE Inc.’s liability exceed the
sum of $1,000.00, including interest and attorney fees.
The consideration received by the undersigned member for this agreement is the reasonable price charged by CONSTRUCTION
NOTICE, Inc. for the service and other valuable consideration, the receipt a sufficiency of which is hereby acknowledged.
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