Madison Ave

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Confirm details

Customer name Co-signer (optional) Property address

City

State

ZIP

Phone

Email

Claim & carrier

Insurance carrier

Type of loss

Claim number

Policy number

Date of loss

Deductible ($)

Property owned by

Remarks (optional)

Subcontract agreement (commercial GC job)

Only needed if you're sending the Subcontract Agreement. Madison is the Subcontractor; the GC signs.

Agreement date

Contract sum ($)

Project title Project address

General Contractor

GC company

GC contact

GC address

GC phone

GC email

Scope & schedule

Scope intro (optional — leave blank for the standard wording) Scope items — one per line, as “Title — description” Price-table line item (optional — defaults to the project title) Exclusions note (prints in bold after the scope) Mobilization date / wording

Payment milestones

Milestone 1

Amount ($)

Milestone 2

Amount ($)

Milestone 3

Amount ($)

Madison signatory

Rep name

Rep title

Contractor authorization

Company signature: not set

Precision certificate — services performed (if applicable):

Pack Out Contents Cleaning Inventory Storage Pack Back Other

Which documents?

Or send these exact documents to the customer to sign on their own device:

Review & sign

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Date signed

Customer reviewed the information form (CIF)

Documents ready.

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By signing below, you agree to the document(s) listed above.

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Full name

I reviewed my information form