AUTHORIZATION TO PERFORM SERVICES & DIRECTION OF PAYMENT

Date*

Client Name*

First

Last

Client Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Primary Contact*

Clients Relationship to Loss Address*

Owner

Owner Representative

Resident

Other

Clients Phone*

Clients Email*

The abovementioned and undersigned Client authorizes Rapid Restoration & Construction, Inc. (hereinafter “Contractor”) to performthe following services (hereinafter “Work”)

These services will be rendered at the above-mentioned property address, and with respect to items that need to be cleaned at aremote location. Contractor may subcontract any portion of the Work.CLIENT SHALL REMOVE ALL CASH, JEWELRY, FIREARMS, VALUABLE COLLECTIONS, PERSONAL & FINANCIAL PAPERWORK OR OTHERDOCUMENTS PRIOR TO THE COMMENCEMENT OF WORK.

Client agrees to pay Client’s deductible in the amount of $ (that applies to this claim)

Client Authorizes*

Insurance Company (hereinafter “Insurance Company”), to pay Contractorsolely and directly for that portion of the Work covered by Client’s insurance policy. Client irrevocably directs the Insurance Companyproviding coverage for the Work to include the name of Contractor on any payment instrument issued in connection with this loss.In the event the Insurance Company includes on the payment instrument other parties (including but not limited to the Client) whenissuing payment to Contractor, Client agrees to promptly endorse the instrument to Contractor and agrees to obtain mortgage companyand/or other endorsements as necessary, within seven (7) days of receipt of the payment instrument. Client understands and agreesthat the payment instrument is the property of the Contractor and failure to obtain endorsement as agreed shall constitute breach ofthis Contract and fraudulent conversion of Contractor’s property.If any amounts owed to RRC for Work are not covered by insurance (deductible, depreciation, adjustments, etc.), Client agrees to paythose amounts to RRC within fifteen (15) days of Client’s receipt of invoice. Client understands and agrees that Client and its agents,successors, assigns and heirs are personally responsible for any and all deductibles and any costs not covered by insurance. Interestand finance charges will be charged at the maximum allowable by law, or 1.5% per month, whichever is less, on accounts remainingunpaid after thirty (30) from the date of the invoice.Client agrees that the Contractor is working for the Client and not Client’s Insurance Company or any agent, adjuster, or consultant.The person signing below represents that he or she is the person properly authorized to enter into this Contract and that adequateinsurance coverage exists to provide prompt payment for the Work.

I have read this authorization to perform services and direction of payment, including the terms and conditions of service on thereverse side hereof, and agree to the same.

Client Signature*

Client Printed Name*

First

Last

Contractor Name*

First

Last

Date /*

CONTACT INFO