Home

Description of service you are requesting:

Name:

Address:

Phone Number:

Email Address:

Credit Card Information:

Visa Mastercard American Express Discover

Account Number:

Exp. Date:

Name as it appears on card:

I UNDERSTAND AND ACKNOWLEDGE THAT The Concierge™ IS A REFERRAL SERVICE AND WILL REFER CONTRACTORS TO ME. ANY ARRANGEMENTS MADE, OR CONTRACTS NEGOTIATED ARE BETWEEN ME AND THE CONTRACTOR. The Concierge™ HAS NOT MADE ANY WARRANTIES, EXPRESS OR IMPLIED TO ME AND SPECIFICALLY EXCLUDED FROM THIS JOB ORDER FORM ARE IMPLIED WARRANTIES OF MERCHANTABILITY AND THAT The Concierge™ SHALL NOT BE HELD LIABLE FOR ANY DELAY OR FAILURE OF CONTRACTOR TO RENDER SERVICES DUE TO FEDERAL, STATE OR MUNICIPAL ACTION OR REGULATION; FIRED DAMAGE TO OR DESTRUCTION IN WHOLE OR IN PART OF HOMEOWNERS PREMISES; LACK OF OR INABILITY TO OBTAIN RAW MATERIALS, LABOR, FUEL, OR SUPPLIES; OR ANY OTHER CAUSES, CONTINGENCIES OR CIRCUMSTANCES WHICH PREVENT OR HINDER CONTRACTOR FROM RENDERING SERVICES OR COMPLETING ITS CONTRACT WITH ME. I HEREBY HOLD The Concierge™ HARMLESS FROM ANY DEFECT IN WORKMANSHIP, DEFAULT, DAMAGE, INJURY OR EXPENSE ARISING OUT OF THE WORK PERFORMED BY A CONTRACTOR REFERRED AND HIRED BY ME FOR ALL JOBS. BY CLICKING SUBMIT YOU AGREE TO THESE TERMS.