Direct Pay Authorization

    THE INSURANCE COMPANY IS
    HEREBY AUTHORIZED TO PAY MY CLAIM IN THE SUM OF:

    DIRECTLY TO MasterDry, LLC (Tax ID 41-2063895) | 28 Ceramic Drive, Martinsburg, WV 25405

    FOR REPLACING AND/OR REPAIRING MY PROPERTY MADE NECESSARY BY THIS OCCURRENCE WHEN THOSE REPLACEMENTS AND REPAIRS HAVE BEEN COMPLETED.

    Insured Signature:

    Date: