Authorization to Bill Insurance

The undersigned named above (“Homeowner”) executes this Work Order, granting AAA Tree Experts, Inc. a Florida Corporation, located at 3610 North Monroe St., Tallahassee, FL 32303, the authority to perform the Scope of Work at the property known as Job Address (the “Work Site”) upon the terms and conditions set forth herein.

This is a contract to perform emergency tree work and related services (the “Work”). This “Contract”, all Price Charts, Proposals, Scopes of Work, sketches and drawings, authorizations, special remarks, and amendments to this Contract shall become a part of this Contract at the time that you initial or execute them and constitute the entire agreement among the parties.

The undersigned is the homeowner or agent acting under the express authority of homeowner, has received and read and understands and agrees to the scope of work, and requests that AAA Tree Experts, Inc. commence the Work.

Direct Pay Authorization: By execution of this Contract, you expressly authorize AAA Tree Experts, Inc. to be paid directly from your insurance company for services rendered without further acknowledgment, consent, or signature from you. To the extent permitted by applicable law, you agree that any attempt to divert or receive directly any such payment contrary to the terms of this Contract shall automatically be a breach of this Contract, for which AAA Tree Experts, Inc. shall be entitled to liquidated damages in the amount of the payment so diverted or redirected plus attorney fees and expenses arising out of such breach.

By signing this Contract, you agree, acknowledge, and understand that this is a binding contract and that you are responsible for prompt payment for Work performed, regardless of whether such Work, or any portion of it, is covered by insurance.

(use your mouse or finger to draw your signature in the box below)