Skip to content
Get Help 24/7
Facebook
Instagram
MENU
Work Authorization
Work Authorization / Payment Terms
Printable PDF
"
*
" indicates required fields
Customer/Responsible Party
*
Date
*
MM slash DD slash YYYY
Project Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mailing/Billing Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone Number
*
Email
*
Antimicrobial Agent Consent
*
I/We understand that Pro Environmental Services may use an EPA registered antimicrobial agent that aids in inhibiting mold and bacteria.
Authorization
*
By checking this box and signing below, we the undersigned agree to the following:
We the undersigned, hereby retain and hire Pro Environmental Services, hereinafter (PES), to perform the services as requested by us, or as specified in their proposal/scope of work, to the property we own, control or lease, and for which we have the right and power to contract for such services.
We accept the payment / terms listed below and understand that we are responsible for any collection fees or court costs to recover these funds. We acknowledge that it is our responsibility to work with the insurance company, if applicable, for loss payment under the terms of our insurance policy. We authorize the insurance company to name as loss payee (PES), for the portion of their work covered in our insurance policy. If our name is on the check we authorize (PES) to endorse the check on our behalf and apply those funds to our bill. We understand that if in default interest will accrue at 1 1/2% per month for all funds not collected within the first 30 days of completion.
IMPORTANT NOTICE:
(PES) shall not be held liable for any unseen, hidden or non-disclosed damages or liabilities both structurally and personally. (PES) shall not be held liable for any potential, pre-existing cross contamination, moisture intrusion or hidden microbial growth. (PES) shall not be held liable for the reoccurrence of moisture or environmental conditions that could create conditions conducive to microbial growth. If hidden damage expands the amount of, or the scope of work, the responsible party will be notified as soon as possible to discuss protocol or resolution.
Terms
Deposit/Draw
Project Type
Full Name
*
Signature
*
Phone
This field is for validation purposes and should be left unchanged.
Printable PDF
Facebook
Instagram
Emergency Services
Services
Mold & Mildew
Water Damage
Fire Damage
Crawlspace Solutions
Moisture Control
Indoor Air Quality
Reconstruction
Specialty Services
Why Call Us
Our Team
Reviews
Service Areas
Contact Us
Call Us 24/7
Facebook
Instagram