Indiana Emergency Restoration Company

Repair Services Release of Claims Form

Please fill out and submit the form below, or download the form here to print and complete.

The undersigned, here-in-after the Releasor(s), have been advised on the recommended procedures to resolve issues occurring at the listed address. However, the Releasor does not wish to adhere to the recommended procedures, and therefor assumes full liability for the above mentioned property. Five Star Complete Restoration Inc., here-in-after the Releasee(s), is not liable for any damages which may occur as a direct result of homeowner's negligence. The Releasor, for ourselves and our respective heirs, executors, administrators and assigns, do hereby completely and fully release and discharge the Releasee(s), of and from any obligation, liability or responsibility arising out of the claim and/or action:

Name*
Which shall be installed by the Releasee at the Releasor’s residence:*
Releasor's name*
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