1. No category

P.O. Box 26830, San Jose, CA 95159 Phone 408‐293‐5818
FAX TO: 408-283-1919 Or EMAIL TO: [email protected]
Submitted By
Date
Preliminary Notice Information
PLEASE PROVIDE THE FOLLOWING INFORMATION FOR YOUR JOB
EDGES Customer Information (Your Company Info) - Required
EDGES Customer
Your Address
Address 2
Your City
State
Your Contact Name
Your Email Address
Your Phone Number
Your Fax Number
Zip
Job Information - Required
Job Name
PO/Job Number
Job Address 1
Job Address 2
Job City
State
Estimated Material Cost
$
Zip
Date of First Labor or Materials Supplied
Private Job? YES
NO
Residential Job? YES
NO
Is the Job Bonded?
YES
NO
Public Job? YES
NO
Federal Job?
NO
Is There a Construction Lender?
YES
NO
YES
Property Owner Information - Required
Owner Name
Address 1
Address 2
City
State
Phone Number
Contact Name
Zip
General Contractor Information - Required
General Contractor
Address 1
Address 2
City
State
Phone Number
Contractor Number
Fax Number
Email
Zip
Construction Lender Information - If Applicable
Construction Lender
Address 1
Address 2
City
State
Phone Number
Loan Number
Zip
Payment Bond Information - If Applicable
Surety Name
Address 1
Address 2
City
State
Phone Number
Bond Number
Zip
For EDGES USE ONLY
Job Number
As Is? YES
NO
Branch (SAC or SJ Only)