Submission Form

    1: Vehicle Information







    Appraised Value*


    Appraised Value (Verified)*

    Additional information about the vehicle

    Business Information



    Physical Address

    Street Address*




    Mailing Address

    Street Address*




    Phone and Email



    Owner Request*
    Owner Request: Owner of the vehicle requested repairs

    3: Vehicle Owner Information

    Owner's First Name


    Owner's Last Name

    Owner's Street Address


    Owner's City


    Owner's State


    Owner's Zip

    4: Terms and Submission

    AUTHORIZATION: I authorize Oregon Lien Source to Act on my behalf to obtain information and to give notice concerning a vehicle(s).

    - By checking this box, you hereby agree to the terms stated in the 'AUTHORIZATION' section above and confirm that the information provided on this form is accurate and truthful to the best of your ability. This checkbox constitutes a digital signature, and must be checked to process this Lien Service Order.*

    I agree to the terms