|
Statement of Satisfaction and Completion |
Authorization to Pay | Sample Authorization to Pay Form
Insured:________________________________________ To: ABC Insurance Company I understand this AUTHORIZATION TO PAY extends solely for the repair expenses covered by ABC Insurance Company's insurance policy and completed as a result of the loss occurring on [date]. My deductible and additional work for repairs not covered is solely my responsibility. I hereby authorize payment on my behalf in the above referenced claim to the contractor(s) below.
To: 1st Action Services $__________________
By Insured:
Company Profile |
Professional Services |
Customer Care | |
