Repair Work Authorization 2017-09-24T10:33:43+00:00

GO PRO CONSTRUCTION AND RESTORATION INC.

1930 VETERANS MEMORIAL HIGHWAY, STE 12, ISLANDIA NEW YORK 11749
EMAIL: GOPRO4012@GMAIL.COM
PHONE: (844) 517-8418
FAX: (631) 410-5522

 

REPAIR WORK AUTHORIZATION

I,



AUTHORIZE GO PRO CONSTRUCTION AND RESTORATION INC TO COMMENCE AND PERFORM THE REPAIR AS REQUIRED UNDER MY CLAIM FOR DAMAGES TO MY PROPERTY LOCATED AT



IN ACCORDANCE WITH THE APPROVED SCOPE OF DAMAGES WITH

(INSURANCE CO) :



IN THE EVENT ADDITIONAL SERVICES OR WORK ARE REQUIRED WHICH ARE NOT CONTEMPLATED BY THE APPROVED ESTIMATE,THEN THE CONTRACTOR SHALL IDENTIFY THOSE SERVICES OR WORK BY WRITTEN CHANGE ORDER, WHICH SHALL BE APPROVED BY BOTH THE INSURANCE COMPANY AND MYSELF IN WRITING. ABSENT COMPLIANCE WITH THIS PROCEDURE, NO ADDITIONAL WORK IS AUTHORIZED AND PAYMENT FOR SUCH WORK WILL NOT BE PAID.

DATE OF LOSS :
TODAYS DATE :
CLAIM NUMBER :



I HEREBY AUTHORIZE

 



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.

PROPERTY OWNER SIGNATURE :