This authorization made on this date: , between USA Restoration Pros, hereinafter referred to as “The Company”, and First Name Last Name, hereinafter referred to as “The Customer”, whereby The Customer instructs The Company to proceed with its recommended work and procedures to restore, preserve, protect and also to secure from further damage the property located at: Street Address City State Zip.Further, it is fully understood and agreed by The Customer that any and all charges for work performedby The Company are the personal responsibility and liability of The Customer. Accordingly, TheCustomer hereby authorizes The Company to charge its credit card for all saidcharges.CARD INFO: (scroll down for bank info)A 3.5% credit card processing fee will be applied to all transactions.CARD NO.: Card Number V-CODE: CVC EXP.: EXP ADDRESS: Street Address City State Zip ACH AUTHORIZATION:NAME ON ACCOUNT: Name on Account ACCOUNT NUMBER: Account Number ROUTING NUMBER: Routing Number PHONE NUMBER: Phone Number TYPE OF ACCOUNT: Type of Account Personal Checking Personal Savings Business Checking Business Savings NAME OF BANK: Name of Bank NAME: First Name Last Name PHONE: Phone Number EMAIL: Email Signature: Signature Date: Date