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<br /> ��I���� Cu,stomer Ip; ����� License�X�GCi3295S#
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<br /> Daie ' EnauranceCompanyName ' da3m23� � � � ' �
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<br /> Customer's Hame{tnsured} " "` {�yg�omgr's Addtrss. � ' y tustomer's Ci1y,.Stase,Zip
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<br /> 'CuStomer's 9est Phone�$Yime� tustumcr',Alt Phane �7a
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<br /> 5hingie Calnr Note:.Harn�awn�r c�nfi�ms he/sh2 has p�rson�lly v2rified the type,styi�,and colnr..a�the shing{es e,��t,ai: �
<br /> ' selected and homeowner.atc�pts futl resannsitiittrv for obt�inan�any necessary H�A app�ovals.
<br /> RCtt3f WCdYIC Ti�ta1(Afl i�uildings); 5Ct• rnittai: t�the�' 1r�itiat: ._,��_..
<br /> 1Viain 6uilditig etached Buil�in Remove&Reait�c at�ie
<br /> 5hingle Ivt cturer"�i lY°r�,.�"rll�3r�- _�� Gara Remove spos�:5ate8ite
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<br /> Shingls Mfr.Warranty:. tr ' S d Re ove&Reattach Anterma
<br /> ;5fiingle.Color. ��`���'�'�'�� C7ther(See Not�sj Remove&Dispas�Antenria
<br /> ; 3tottenJUn-Nallable wqad:We wili include the reptarement of twa A`x8'sheets ai OSe esr CDx decking�To maich exisitng ,_... �
<br /> decking).,Each addicional sNeet vai11 be;instailed at S45.Ci0 each.Zx�iruss scabbin�wtl be�ailled�c$3 per lE.Zx4�nii Zzcb �n�tial: �.�.=
<br /> �ascia wiN be 6iiled at$4 per'i.E:.Safiit.tvili.6e tiitled at$5;per LF.Pi3ies.do nat include patritsng:
<br /> Su�piem�nt�CAuthorization ��,�r,�i: Installation P�ym�nt i������= , °'- .�
<br /> 1�gr�e to a Southi�rn Fro-Restarati�n tr�requ�sf suqplemen funds frsin Hosn�owner a�ree�to r.elease:the arnoun etaw �
<br /> �iray iiisu�ance coinp, or mistak�s;items ri�iss m�c6`�t p ice incr�ases, incfu�ing the insurance dedun�bie/upgrades(uniess
<br /> overhead.and profir,efc.that ay not be reflected an my in�urance atherwise ag�eedy Yo Southem Pro Restoration,on.th�
<br /> S�ttt2ment Sta . .agr�e to:r2lea�'� �mental funds to Sauthern Prp day of tristaii�tion.Homeown�r agre�s NOT td.u+rttihold
<br /> Rest ' n if appr�nved.This vuifl nac•affert tNe amoun 'i�Yf�ue-xo pay aut-of- this payment over.�ninar conszructic,n def�cts;J disputes,
<br /> pocket. Amaunt 17u�:ac InstaUation:$
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<br /> ��}gWd��S tniY�al: �� P��/I71@tl� Initiai: + '�-
<br /> £�(�`�c i��y t•t��t;. �� �'✓ s,C..
<br /> Shtngie ilrifr,lNarrann'� YR, SQ. S , Rt�tif:.$
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<br /> t3�ip£dge Colot: `'�,'��I J"�� 1.F. 5 tJpgrat�es:$ �'��_...
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<br /> T�tal Up�ra`de�;$ Stib Tcital:$_ �;tY��'� –
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<br /> Additic�nai Terrri�f Nates Total Paid Today:�$. ��.�� 'I
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<br /> z�c����,�*:$ _ �,
<br /> � L���� p �� ��ti�,� , 'Total 0ue fs the amourtt du�priar io ai!-suppiements
<br /> �"'�� ��` � '�'�" ��� � andjor overhearl and profit.,
<br /> � G� � 1 , `������A A�.�'"'�'—` A 1 rights and afaSigations"o the,parties shaii be su ject ko'
<br /> "`� ��'t°`' '�"i and gaverned by the�"eneral Terms an�l Conctitions.a�'
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<br /> ' i w rev�rse side,amendsnent(sj{�f appiica6l�),and this si�ned.
<br /> - . �1��"7 ���t ���"�"" Roaf Work Order 1��voiee includi��g any subse�uent
<br /> rnodifications�re hzr�by iricorporated by r�ference ani�
<br /> �ct�c#ied as Exiiibit(s)i�uiy accepfed arid si�iied by,btith:
<br /> parties.Rit work.au rized wi p 1N7thiti thp 1rOfk SCi7�5£Q�
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<br /> Cu�o ,ei's Signature Oate . uthorized�gen�5ignatur� Phone
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<br /> Custnmer°s Name(Printedj . Oate. Authqrized,�gen1'Name.(Prinied) Datz
<br /> CAp5rlght XO10 t47.5outh�<n Eri�fte3tar�tiaR.ttG�U26t�6ay F��:�°�ud,Sw1e 5Ui-Tsrn�a,�L 33�19•Pi2e+se•�I3.�35.12C9-F�x:888,a;��7.t97i2
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