Lien Clearing Request Form

* = required field.

Before completing this form, review the Lien Clearing Information.

* First Name:

* Last Name:

* E-mail:

* Phone Number:

* Department:

Order/Tracking Number:

* Is Order Closed? Yes No
Special Note: Please be aware that, once we have
corrected the lien, you should have no other financial
activity against this purchase order.

Document Number:
Special Note: If there is no order number, please
provide DaFIS document number.

* Full Accounting Unit:

COA

Account

Sub Acct

Object

Sub Obj

Project

Amount

Additional Information:

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