Authorized Pickup Authorization Form

AUTHORIZED PICKUP AUTHORIZATION FORM

Parties

Recitals

WHEREAS, Client Name: is the lawful owner or authorized representative of the goods described below and desires to authorize persons identified in this form to take possession of those goods from the Service Provider; and

WHEREAS, Service Provider Name: agrees to release possession of the goods to agents who present valid identification and this written authorization, subject to the terms and conditions set forth herein;

WHEREAS, this authorization becomes effective on and applies only to the items and agents specifically identified in this document.

Authorized Pickup Agent(s)

Enter up to three authorized agents. Each authorized agent must present a government-issued photo identification document at the time of pickup.

Scope of Pickup

Describe the items, documents or property to be released. Include quantity, specific identifiers (serial numbers, account numbers), packaging, and any special handling instructions.

Payment Terms

The Client agrees to pay any applicable pickup or processing fees as set forth below. Failure to timely remit fees may result in withholding of released items until payment is received.

Term and Termination

This authorization is effective beginning on and expires on unless earlier revoked in writing. Either party may terminate this authorization upon days' prior written notice to the other party.

Confidentiality

The Service Provider shall treat all non-public personal information contained in or associated with the items subject to this authorization as confidential and shall not disclose such information to third parties except (i) as required by law, (ii) with the prior written consent of the Client, or (iii) to agents performing obligations under this authorization who are bound to confidentiality obligations no less restrictive than those herein.

Liability and Indemnification

The Client represents that the individuals listed as authorized agents are permitted to take possession of the listed items. The Client authorizes the Service Provider to rely on this written authorization and to release items to any authorized agent who presents the required identification. The Client releases and holds harmless the Service Provider and its employees, agents and contractors from liability for loss, damage or delay resulting from release of items in reliance on this authorization, except to the extent caused by the Service Provider's gross negligence or willful misconduct. The Client agrees to indemnify and defend the Service Provider against third-party claims arising from the Client's false representations, failure to disclose material information, or unauthorized agents.

Governing Law; Entire Agreement

This authorization shall be governed by and construed in accordance with the laws of the jurisdiction agreed by the parties. This document contains the entire agreement between the parties with respect to the subject matter herein and supersedes all prior understandings, representations and agreements, whether written or oral.

Certification

By signing below, the Client certifies under penalty of perjury that the information provided is true and correct, that the named agents are authorized to accept possession of the identified items, and that the Client will be responsible for any fees or liabilities arising from authorized pickups. The Service Provider acknowledges receipt of this authorization and will take reasonable steps to verify the identity of authorized agents prior to release of property.

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