Home Daycare Billing Authorization Form

Home Daycare Inspections

BILLING AUTHORIZATION FORM

Inspection Terms:

By submitting this form you authorize Renton Regional Fire Authority (RRFA) to bill the undersigned Owner/Authorized Agent for the inspection costs incurred relative to the Home Daycare specified on this form at a rate of $175 per hour. A minimum of one hour will be charged. Partial hours thereafter will be prorated to the nearest quarter hour. Inspections will not be scheduled after the RRFA Office of the Fire Marshal's standard office hours, on weekends, or on federal holidays.

Name of Home Daycare *

Address of Home Daycare *

Address Line 1

Address Line 2

City

State

Zip Code

Billing will be sent to:

Name of Owner/Authorized Agent *

First

Last

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Billing Authorization: *

The Owner/Authorized Agent agrees to the Inspection Terms above and agrees to pay for the requested inspection.