Agreement & Authorization Form

This form gives Shaq’s Restoration Services LLC. permission to:

Access client’s property in order to inspect, measure, estimate, diagram, and photograph any necessary items relevant to the potential insurance claim

Meet with client’s insurance adjuster on site to review scope of damages and discuss claim in order to reach a settlement.

Grants Implied/Express Authorization for Shaq’s Restoration Services LLC. to correspond with client’s insurance company on behalf of client via phone, email, fax, etc. in order to facilitate any further supplements and final invoicing relevant to claim.

Owner’s out of pocket expense not to exceed deductible plus upgrades for non-insurance related claim items.

Right of cancellation pursuant to federal regulation: You, the customer, may cancel this transaction at any time prior
to midnight of the third business day after the date of this transaction.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Acceptance by Owner:

Date:

Representative Signature:

Date:

141440
SHAQS RESTORATION SRVC LLC