Authorization – Air Resolutions

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AIR Resolutions LLC Authorization Form

I authorize AIR Resolutions LLC and all/any affiliations, to perform the requested service(s).AIR Resolutions LLC and all/any of its affiliations, its agents, employees, or subcontractors agree to furnish the trained personnel and equipment and insurance necessary to perform the service(s).

Please fill out the fileds below.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Type of Service(s)(Required)

Remediation Work Plan*

Post Remediation Verification *

Air Quality Assessment* (does not include recommendation report)

Indoor Environmental Assessment*

Indoor Allergen Assessment (add on)

Assessment Consultation

Interior Redesign Consultation

To be determined by assessor

Remediation Work Plan*(Required)

$1200 (up to 3500sf)

$1800 (3500 - 5999sf)

TBD (6000sf+)

Post Remediation Verification*(Required)

$600 (up to 3500sf)

$800 (3500 - 5999sf)

TBD (6000sf+)

Air Quality Assessment* (does not include recommendation report)(Required)

$600 (up to 3500sf)

$800(3500 - 5999 sf)

TBD (6000sq+)

Indoor Environmental Assessment*(Required)

$250(up to 3500sf)

$500(3500 - 5999 sf)

TBD (6000 sf+)

Indoor Allergen Assessment (add on)(Required)

$600.00

Assessment Consultation(Required)

$150/hr - no report (*Consultations are included with all above assessments free of charge)

Interior Redesign Consultation(Required)

$250 initial consultation

* Prices may vary based on property size, scope of work, available discount offers, specialty testing/assessments necessary.
Additional 5% administration fee for all credit card, Venmo or ACH payments will be applied to the invoice
Prices are based on square footage of property based on Property Appraiser, not on testing area.

I am the owner, or have the owner's authorization to contract with AIR Resolutions LLC, and its affiliates , to perform the requested assessment and/or reporting and/or consultation. I understand that AIR Resolutions and its affiliates do not perform remediation services.. Air Resolutions LLC and its affiliates do not have or permit 3rd Party Billing or Invoicing. Invoices will be sent directly to the property owner or contractor. In no way shall this service authorization be construed as an Assignment of Benefits. The property owner is ultimately responsible for paying any and all charges as a result of services provided by AIR Resolutions LLC upon completion. I agree to pay this invoice for services agreed upon initial services prior to receiving any reporting. If approved to pay at completion of all services, when billed by AIR Resolutions, LLC, and its affiliates, I agree to deliver such monies (check or credit card payment via invoice) within 24 hours after receipt. I authorize this company to charge my credit card listed for services and fees rendered if payment is not completed when due which will also include administrative fees.

Payment Information (we will not process credit cards unless the payment is not completed via invoice by the ordering party when due.)

Credit Card

Received on date of Service(Required)

Payment made online on date of service or prior to service(Required)

If failure to pay via the emailed link, you authorize AIR Resolutions, LLC to charge the above credit card for the services performed as disclosed on this authorization form and I acknowledge that there may be administrative fees added to the invoice.(Required)

(initial) AIR Resolutions LLC, will send you a payment link to pay for the performed authorized services.

(Required)

(initial) I authorized AIR Resolutions LLC to send my report to any requesting parties.

(Required)

(initial) I authorize photo or video documentation to be taken of my property for related services

Invoicing & Payment Services: I (we) agree to pay AIR Resolutions LLC and all/any of its affiliations upon completion of service(s) or in an agreed upon time and method of payment. If payments are not received within one day of invoice day or the agreed upon date, late charges will be applied to the invoice. All overdue invoices will be charged a 10% late fee + additional $25/mo late charges.. I am on notice that failure to pay AIR Resolutions LLC and all/any of its affiliations may result in legal action against me including collection efforts by a collection agency or attorney. In the event it goes to the collection agency, there will be an additional fee of 20% due of the total amount of the bill. I agree to pay all collection fees and/or attorney fees incurred. I agree there are no warranties, either expressed or implied, written or oral and AIR Resolutions LLC and all/any of its affiliations liability to me or anyone claiming through me or under me, for damages to persons or property caused in whole or in part by any act, omission, or default of AIR Resolutions LLC and all/any of its affiliations, it's agents, employees, or subcontractors Including liability for its own negligence, is limited to the amount of my deductible actually paid or $500.00, whichever is less.

Consent(Required)

I fully understand the form and all of the details I indicated are correct.

AUTHORIZING PARTIES SIGNATURE ACCEPTING SERVICES:

DATE:

AIR Resolutions LLC Authorization Form

THE OWNERS

THE LOCATION

THE CONTACT