Third Party Authorization Letter


Insurance Company:

Claim Number:

Insured Name:

Property Address:


 

TO WHOM IT MAY CONCERN,

Please note the following information in your system:

I hereby appoint Falcon Roofing and its successors and or assignees to discuss any and all matters concerning my aforementioned claim. Falcon Roofing and its successors and or assignees are authorized to work with my Insurance Company, and to receive and inspect any and all information regarding my claim documents you have on record. I also request you send all claim documents to the designated agent. I understand that I am solely responsible to review all information sent by my Insurance Company to Falcon Roofing and its assignees concerning my payment request.

 

Designated Agent: Steve Darakhshan

P: (855) 409-ROOF
E: [email protected]
www.falconroofingva.com

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Signed by Steve Darakhshan
Signed On: August 13, 2021


Signature Certificate
Document name: Third Party Authorization Letter
lock iconUnique Document ID: 734ece649e7d43de33eadb3ccd723bfef83de120
Timestamp Audit
August 13, 2021 7:17 pm ESTThird Party Authorization Letter Uploaded by Steve Darakhshan - [email protected] IP 50.78.6.46