290 Heritage Ave., Ste 1
Portsmouth, NH 03801
Office 603-430-7701 | Fax: 603-373-6214
___________ ___________, herein referred to as “Customer,” authorizes Insurcomm, Inc., herein referred to as “INSURCOMM” to perform any and all necessary restoration services on
Customer’s property at: ______________, ______________, ______________
Customer authorizes _______________ Insurance Company, herein referred to as “Insurance Company”, to pay INSURCOMM solely and directly.
If for any reason the check should come to or be made payable to Customer, Customer agrees to pay INSURCOMM immediately upon receipt of the check from the Insurance Company. In order to expedite payment to INSURCOMM, Customer hereby appoints INSURCOMM as attorney-in-fact, authorizing INSURCOMM to endorse Customer’s name, and to deposit Insurance Company checks or drafts for INSURCOMM services. Customer agrees to pay Customer’s deductible in the amount of $______, that applies to this claim and also if the loss is not covered by insurance, Customer agrees to pay the total amount to INSURCOMM immediately upon receipt of the invoice amount.
It is fully understood that Customer and it agents, successors, assigns and heirs are personally responsible for any and all deductibles, depreciation, or any costs not covered by insurance. Any and all costs for services not reimbursed by the Insurance Company are the responsibility of the Customer and are to be paid upon completion of work. However, additional work will not be performed unless approved by the customer.
The liability of INSURCOMM is expressly limited to the total amount of the services authorized herein.
Insurcomm agrees to acquire all necessary demolition and construction permits as needed and to have all necessary inspections completed before any walls are closed in. Property is to be restored to its former state, allowing for modern construction techniques and current building codes.
If INSURCOMM submits this account for collection, Customer agrees to pay interest at 1.5% per month or at the highest rate allowed by law, court costs, reasonable attorney fees and all costs of collection.
Customer agrees that INSURCOMM is working for the Customer and not the Insurance
