CALL US

(806) 687-0201
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ADDRESS

3330 70th Street, Suite 204
Lubbock, Texas 79416

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INCIDENT/PROPERTY DAMAGE REPORT
POLICY FORM

INCIDENT INFORMATION
INCIDENT REPORT

Please provide a brief description of the type of damage:

  • I agree that I created the damage and I am held accountable for the cost of repair.

  • I agree that if a damage is made by me that Double T cable Services will deduct from my paycheck until the balance of the damage claim is paid in full.

  • I agree that if my employment is terminated for any reason whatsoever, that any unpaid balance will be deducted from any compensation due to me at the time of my termination.

  • I agree if my compensation does not cover the outstanding balance, I agree to pay Double T Cable Services, Inc. within ten (10) calendar days of termination for the remaining unpaid balance.

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