Emergency Completion 2017-09-24T09:59:00+00:00

GO PRO CONSTRUCTION AND RESTORATION INC

1930 VETERANS HIGHWAY, ISLANDIA NY 11749
PHONE: (631) 410-5522

 

EMERGENCY WORK AUTHORIZATION FORM

I



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

DESCRIPTION OF EMERGENCY
SERVICE(S) TO BE PROVIDED:
DATE OF LOSS
DATE OF SERVICE
INSURANCE COMPANY/CLAIM NUMBER


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.

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