LandAmerica Home Warranty Authorization Form

Authorization/Report Form
Work Order #
Your Zip Code

Tech Invoice # State

Company Name:
Property Address:		Homeowner's Name:

Initial Contact Date:

Service Date:

Expected Completion Date:

Trade Call Fee Amount:

Collected:

Will be Collected

Cost of Parts:

Tax:

Labor:

*Total Estimate:

*DO NOT deduct trade call fee if already collected or will be collected at completion.

Full description of Work: (Include: make, model, serial number, general condition of equipment, description of failure, cause of failure, repairs required)

This form is for Authorization Requests and Reports ONLY. You will not be paid from this submission.