County Locksmith Inc

Authorization For Security Hardware and Emergency Service


I hereby certify that I (customer) have the authority to order material and work repair services from County Locksmith Inc (service provider). I agree that the information I am providing is true and correct. Further, to the maximum extent permitted by applicable law, I agree to indemnify and hold harmless County Locksmith Inc and related parties providing security service from any and all liability or claims that may arise from the performance of their service. I further agree to indemnify the Locksmith and their affiliates successors, assignee’s, and nominees from any and all claims, losses, or cost (Including reasonable attorney’s fees) arising from any acts or omissions of the service provider, the Provider’s employees, subcontractors, or agents.
 
Note: If owner of property is out of town then a drivers license is required to be faxed at (561) 348-2117

Customer First Name: Required.

Customer Last Name: Required.

Email:  

Date:

Customer Drivers License:   Only if instructed to.

Address:

 

Job Description:

 

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County Locksmith Inc https://www.countylocksmithinc.com
Signature Certificate
Document name: Authorization For Security Hardware and Emergency Service
Unique Document ID: 7e74cc7f020799d9a4d62ab311ca389a6c3333bb
Timestamp Audit
2015-12-13 14:24:03 EDTAuthorization For Security Hardware and Emergency Service Uploaded by Rafal Baez - ralph@countylocksmithinc.com IP 73.139.208.200