Insurance Form

406 Roofing is authorized to act at the request of Homeowner to negotiate insurance claim amounts for the address entered and signed for below. Homeowner authorizes insurance company to release insurance payments directly to 406 Roofing and 406 Roofing will complete the work agreed upon. In the case that Homeowner receives payments directly from insurance, Homeowner agrees to pay 406 Roofing immediately upon receiving funds from insurance.

By signing below, you are authorizing 406 Roofing to negotiate claims and serve as beneficiary on your behalf for the insurance policy and property stated below.