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