LiensNC
Request to Register as a Lien Agent
The following information is required to be submitted to the North Carolina Department of Insurance pursuant to NCGS 58-26-41(a). The following will be posted on the NCDOI website and available upon request.
Name of Title Insurance Company/Agency
________________________________________________________________________________
Web Portal: c/o LiensNC,
Physical Address:
c/o LiensNC
19 W. Hargett Street, Suite 507
Raleigh, NC 27601
Mailing Address:
Same as above______________________________________
Telephone Number of Lien Agent:
1-888-690-7384_____________________________________
Fax Number of Lien Agent:
1- 913-489-5231____________________________________
Email Address of Lien Agent:
support@________________________________
[pic] We wish to serve as a Lien Agent pursuant to NCGS 44A-11.1
__________________________________________________ ________________________
Signature of Company Representative Date
................
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