Courtesy of
North Suburban Builders Association
3442 Babcock Blvd
Pittsburgh, PA 15237

 

Emergency Waiver Form (Change Order) Sample

From PA Consumer Protection Act, Section 201-7 (2 and 3):

To obtain a waiver under this section, the seller must furnish the buyer with an emergency work authorization form, as well as a written estimate of the goods or the performance of services. This authorization will allow the seller to immediately proceed with the delivery of the goods or the performance of the services necessary to remedy the bona fide emergency.

The emergency work authorization form provided for in this section shall be:
(i) on a preprinted card at least four inches by six inches in size; and
(ii) the writing thereon must be in at least ten-point bold face type in the following form:

Emergency Waiver Form

Emergency Work Authorization
__________________________________(Enter date of Transaction)


You, the buyer, having initiated the contract for the goods and services of __________________________________________(enter the name of the seller),

the seller, for the remediation of a bona fide emergency hereby authorize the seller to immediately proceed with the delivery of goods or the performance of services necessary to remedy the bona fide emergency. By providing the seller with this authorization, you
agree to make full payment for the goods or services provided. You agree not to exercise the rights afforded you by the Unfair Trade Practices and Consumer Protection Law to cancel the contract within three business days from the above date.


You, the buyer, attest that the attached estimate is an accurate description of the goods and services which will be provided by the seller for the correction of the bona fide emergency:
___________________________________________________
(date)
___________________________________________________
(Buyer’s signature)

 

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