Lockbox Authorization

In an effort to effectively provide restoration services, we would like to place a lockbox at the property that contains a key to allow entry when you are away.

We need you, as the insured, to sign giving us expressed permission to place the box at the property and authorize unaccompanied entry.

Please supply consent to using a lockbox and provide us with a 4-digit pin number below.

This is not a requirement, you have the option not to consent to a lockbox.

Hidden

Client's Loss Information

Insured #1 Full Name:(Required)

Insured #1 Email:(Required)

Insured #2 Full Name:

Insured #2 Email:

Address of Loss:(Required)

Insured Contact Phone Number:(Required)

Date of Loss:

Insurance Company:(Required)

Policy Number:(Required)

Claim Number:

Insurance Carrier Phone:

Default Carrier Claim Email:

Adjuster Contact Name:

Adjuster Email:

Restoration Contractor:(Required)

Contractor Contact Email:(Required)

Contractor Documents Email:(Required)

Section Break

Lockbox Authorization

Insured acknowledges:

1. A lockbox is designated as a repository of a key to the above property, permitting access to the interior of the structure using a 4-digit pin number / combination. This access is given to our company and our authorized personnel, whose part in the execution of our services requires that they have physical access to the structure. The lockbox is not designated or intended as a security system.

2. We advise and request owner and tenant (if any) to safeguard or remove any valuables now located within the structure. Owner and tenant (if any) are advised to verify the existence of, or obtain personal property insurance through the owner’s or tenant’s insurance agent.

3. It is not a requirement that Owner allow a lockbox to be placed on the structure.

4. Where a tenant/lessee occupies the structure, the tenant/lessee’s written consent is also required.

Please supply a 4-digit Pin Number for Lockbox(Required)

Final Step: Sign & Submit

Insured #1 Signature:(Required)

Date Signed by Insured

Insured #2 Signature (if applicable):

Date Signed by Insured

Hidden

Contractor ID