Mold Payment Authorization

INSURED SIGNED DIRECT PAY & WORK AUTHORIZATION

Mold Remediation Work

Customer Information

Customer Name:

Address:

Contact Number:

Email:

Work Description

Work Completed On:

Payment Authorization

I, the undersigned, authorize ZeroVap to be paid directly for the services rendered as specified below:

Total Amount Due:

Payment Method:

cashzellecredit cardcheck

Payment Processing: If payment is made via Zelle, Credit Card, or Check, the funds will be transferred to the company directly. If payment is made in cash, the technicians will receive the payment at the time of service.

Work Authorization

I hereby authorize ZeroVap to perform the mold remediation work described above, and confirm that I have been informed about the scope of work and agree to the terms.

Customer Signature

Printed Name:

Date:

August 07, 2026

Licensed & Insured•CA License #1058199

Questions? Call us at (888) 994-0868