Authorization 2017-09-24T10:20:47+00:00

GO PRO CONSTRUCTION AND RESTORATION INC.

EMAIL: GOPRO4102@GMAIL.COM
PHONE: (844) 517-8418
FAX: (631) 410-5522
SUFFOLK LICENSE NO. 53984

EMERGENCY WORK AUTHORIZATION FORM

I

AUTHORIZE GO PRO CONSTRUCTION AND RESTORATION TO PROVIDE EMERGENCY SERVICES AS DESCRIBED BELOW:



I AGREE TO PAY GO PRO CONSTRUCTION AND RESTORATION INC DIRECTLY
FOR THEIR SERVICES RENDERED. I FULLY UNDERSTAND THAT I AM
RESPONSIBLE FOR THE PAYMENT OF MY DEDUCTIBLE.