Fillable Utility Activation Authorization De-Winterization (Page 5 of 5) in pdf

NON-STANDARD UTILITY ACTIVATION REQUEST

Date: ______________________

HUD Case #: _________―________________________

Buyer’s Inspection Date: ________________________________________

Property Address: _____________________________________________________________________________________________

City: _________________________________________________ State: ______________________Zip:________________________

The above referenced property has been found to have the following deficiencies preventing the activation of all utilities for a

buyer’s inspection.

____________________________________________________________________________________________________________

No de-winterization or re-winterization will be completed by A2Z Field Services. In order to complete appropriate portions of the

buyer’s inspection, the Purchaser and Buyer’s Agent request to activate the following utilities:

Requested Activations

Approved

Denied

Reason

Electric

Water

Gas

Other

_________________________________ / _____________

Authorized Signature, A2Z Field Services / Date

The Purchaser and the Selling Agent must acknowledge the following:

1. The undersigned Purchaser and Buyer’s Agent acknowledge that A2Z Field Services will follow up in seven (7) days to

confirm the buyer’s inspection has been completed.

2. The undersigned hereby agree to forever hold harmless the U.S. Department of Housing and Urban Development,

A2Z Field Services, and its subcontractors from any and all liability. Furthermore the undersigned will assume all and

full financial responsibility for any damages which may occur as a result of any actions and agrees to pay

immediately for the remediation and/or correction of any and all damages caused during the time the utilities are

activated for inspection.

Purchaser may not in any way occupy, perform work on, or alter securing and/or entry locks of said property until

the official closing is complete.

Buyer’s Agent: ____________________________________ Agent Cell#: ________________________________________________

Agent Email: _____________________________________ Agent Fax #: ________________________________________________

Purchaser(s):________________________________________________________________________________________________

Purchaser Cell #: __________________________________ Purchaser Email: ____________________________________________

___________________________/___________

Purchaser Signature/Date

Agent Signature/Date

Page 5

CONTACT A2Z FIELD SERVICES: 1-877-342-1068 (OPTION 2)

Revised 5/26/16

Utility Activation Authorization De-Winterization Page 5