Authorization

For Security / Emergency Services

Date Requested:__________________ Time requested:_________________ AM PM

Street Address:___________________________________________ Unit #__________________

City:_____________________ State:________________________ Zip Code:________________

Contact person on site:____________________________

Contact Phone #____________________________________

Services Requested: _______________________________________________________________

______________________________________________________________________________________

How many keys?________ Release keys to:______________________________________

I hereby certify that I have the authority to order the lock, key or security work designated above. Further I agree to absolve the locksmith who bears this authorization from any and all claims arising from the performance of such work. I agree to bear responsibility to ensure that payment is made to Old Capitol Lock Services for all charges for such work. I also agree to pay all collection costs necessary to collect these charges, and to offer the property involved as security for payment.

Name:__________________________________ Authority to order services:_____________________

Address:______________________________ Date: _____________ Time:____________ AM PM

Phone:_________________________ Signature:___________________________________________

Please complete and fax to (707)745-6221. Every effort will be made to accommodate dates and times requested. Be sure to include a call back phone in case of scheduling conflicts.