PERMIT DOCUMENTSReviewed for
Kahns
Code Compliance
06/05/2020
Reviewed for
Kahns
Code Compliance
06/05/2020
Home Improvement Agreement: Page 1
Home Depot License #'s - For the most current listing visitwww.Homedepot.com/LicenseNumbers
EC0001440, EC13007199, CGC1514813, CGC1522717, CGC061641, CRC046858, CAC1813767, CAC1818831, CFC1426021, CCC1331113, CCC1331130, CCC05830;
Reviewed for
Kahns
Code Compliance
06/05/2020
Salesperson Name:Registration No. (if applicable):
Home Depot U.S.A.,Inc.("Home Depot") or Service Provider named below will furnish, install and/or
service the equipment listed below at the price, terms and conditions as outlined on this form.
BRIERLEYJAY02241-81781549283
Customer Last NameCustomer First NameStore # / Branch NameCustomer Lead/ PO#
5 Walcott DriveBOYNTON BEACHFL33426
Customer AddressCityStateZip
561-281-0959JAYNYR@AOL.COM
Home Phone#Work Phone#Cell Phone#Customer Email Address
NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR
OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT:
8402 LAUREL FAIRTAMPAFL33610
AddressCityStateZip
Or Email:
Service Provider Email Address
BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE
SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT
CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE.
YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME
DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME
DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE
SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED
TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN
SHIPMENT AT HOME DEPOT'S EXPENSE.
THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT
TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL
AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL.
Acknowledged by:
Customer's SignatureDate
Contract Price and Payment Schedule: Payment of the Contract Price is due upon signing unless a
different payment schedule is required by law, specified below or in a payment addendum.
Contract Price:$Includes all applicable taxes. Excludes finance charges.*
Sales Tax:$(If applicable)
*Maximum deposit ONLY applicable in MD, MA, ME (33%), NJ, WI (99%)
Dep.%
Deposit Amount $Remaining Balance $
The Home Depot - 2455 Paces Ferry Road, N.W. Bldg. B-3, Atlanta, Georgia 30339 - Customer Care: 1-800-466-3337
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Home Improvement Agreement Page2
Finance Charges: Any interest payments or other finance charges will be determined by Customer’s
separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition
to Customer’s payment under this Agreement. Customer is subject to the terms and conditions of the
cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider;
however, Service Provider may collect Customer’s payments made payable to Home Depot.
Insurance proceeds will will not be used to pay some or all of the total amount of sale.
Reviewed for
Kahns
Code Compliance
06/05/2020
Description of Work to be Performed: A detailed description of the work to be performed is included
in the paragraph entitled Scope of Work or Specification which is included in this Agreement.
Anticipated Delivery Date / Installation Schedule
Approximate Start Date:Approximate Finish Date:
All dates are approximate and subject to change based on unforeseen events including inclement
weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if
applicable.
Electronic Records Authorization: You are entitled to a paper copy of this Agreement if you choose.
If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent
documents and written communications related to this Agreement. By contacting your Service Provider,
you may update your email address, withdraw your consent, or obtain a paper copy of the Agreement or
related documents at no charge. By providing your consent and verifying your email address above, you
confirm that you have access to a computer that can receive and open emails and PDF documents.
I do do not consent to receive only electronic records related to this transaction.
Acceptance and Authorization: By signing below, you authorize Home Depot to: (a) arrange for
Service Provider to perform any Services or (b) order and arrange for the delivery of special order
merchandise, including special order merchandise that may be custom made, as specified in this
Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to
be provided to You later.) By signing, you acknowledge that: (i) You have read, understand, and accept
this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You
are receiving a complete copy of this Agreement; and (iii) all rights and interests under this Agreement
are solely vested in the person listed as “Customer” above.
FLORIDA DELTA MECHANICAL
X
Customer's SignatureDateService Provider Name
X
8402 LAUREL FAIR
Co-Signer (if applicable)DateService Provider Address
TAMPAFL33610
X
Signature On Behalf of Home DepotDateCityStateZip
888-536-9181
Service Provider Phone NumberService Provider License Number
The Home Depot - 2455 Paces Ferry Road, N.W. Bldg. B-3, Atlanta, Georgia 30339 - Customer Care: 1-800-466-3337
268 Water Heater (19 Jun. 18) (C)v50.0.0