Work Authorization Form

    Ordered By:

    Person/Company Responsible for Payment

    Name

    Company (if applicable)

    Phone Number

    Mailing Address

    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

    Is this a Refinance?
    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 *PDF or JPEG Format

    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 Company Contact (email or phone number)

    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.

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