Work Authorization Form

Ordered By:

Person/Company Responsible for Payment

Name
Company (if applicable)

Mailing Address

Phone Number
City

State
Zip

Fax #
Email Address

Name of Realtor/Agent (if different from above)
Realtor/Agent Phone #

Physical Address of Survey

Job Address
New Construction
YesNo

Legal Description

Lot
Block
Subdivision Name

Phase
City
County

*If acreage survey, please fill in the following and upload current deed.
# Acres
Name of Survey
Abstract #

Upload Current Deed

Description of Work

Please check one of the following
Boundary & Improvements SurveyForm CheckLot StakeElevation CertificateOther

Closing Information

if applicable

Buyer
Current Owner

Closing Company
Closing Date
Date Needed By

I understand that I and/or my company are responsible for the full payment of any and all charges associated with this work order. This authorization is to be governed by the laws of the State of Texas and venue shall be in Bell County. The undersigned agrees that, to the fullest extent permitted by law, the Firm's total liability to the Client for any and all injuries, claims, losses, expenses, damages or claim expenses arising out of this agreement from any cause or causes, shall not exceed the fee charged. Such causes include, but are not limited to, the Firm's negligence, errors, omissions, strict liability, breach of contract or breach of warranty. This work order form is to be approved by the Firm prior to any work being started. This agreement may be waived, abandoned, modified, amended, discharged or terminated only with a written instrument signed by both parties. This instrument contains the parties' entire agreement. There are no written or oral agreements that are not fully expressed in it. After completion of the work if the fee is not paid within 30 days then the amount owed shall accrue interest at the rate of 2.5 percent interests per month. Estimates are given based on information provided by client.

Signature