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Private Pay Work Authorization

  • Insurcomm

    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 Insurcomm, Inc. to perform work as follows at: ______________, ______________, ______________

    It is fully understood that customers, successors, assigns and heirs are personally responsible for any and all costs.

    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.

    Customer agrees to pay a deposit in the amount of 50% of the estimated repair prior to commencement of work. The balance will be due upon completion. Any and all work necessary may not be included in the initial estimate and will be billed upon completion.

    Please call 603.430.7701 in order to make the deposit in the amount of 50% prior to the commencement of work.

    If INSURCOMM submits this account for collection, the 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.

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