Quality Control Order Form

$1,000

Your Company Name

Your First Name

Your Last Name

Your Email Address

Your Phone Number

Insureds First Name

Insureds Last Name

Loss Location Address

Insureds Phone Number

Insureds Email Address

Claim Number

Policy Number

Additional Important Information

All boxes must be checked before submission of order Required

Client shall defend, indemnify and hold Parker Solutions, Inc., its officers, officials, employees and volunteers harmless from any and all claims, injuries, damages, losses or suits including attorney fees, arising out of or resulting from the acts, errors or omissions of Parker Solutions, Inc.

Client understands that Parker Solutions agrees to a non-disclosure of any and all confidential information provided to them by your company.

Client understands that payment must be made before services will begin.

Your Signature

Thanks for your order!

Please email all relevant documents to claims@theparkersolution.com