Signature Authorization Release Email* Today's Date*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Use Calendar IconYour Name* First Last Your Title*Company Full Name*Company Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Office Phone*Cell Phone*If this signature is for a particular job, please enter the name here.Consent* I agree to the Signature Authorization ReleaseSignature Authorization Release In accordance to the ESIGN Act of 2000, 15 U.S.C. ch. 96, Nationwide Security Service is providing its clients with the convenient option of keeping authorized signatures on file for the purpose of releasing and digitally signing service requests and service agreements in your absence or in lieu of physically signing documents. By signing this Signature Authorization Release agreement, you, the client, or its authorized agent agree to digitally store your signature on file with Nationwide Security Service Inc, and give us the authorization to affix the likeness of your signature in order to bind service requests, agreements, or change orders. In lieu of physically signing documents that require your signature, you may, with respect to our Terms & Conditions, elect to click the option for Signature Release when submitting service requests. Upon such consent, we shall affix your signature to the service request and your signature shall be binding. You agree: 1. To have Nationwide Security Service Inc, store the digital likeness of your signature for future use in binding service agreements and service requests in the absence of your ability to physically sign documents. 2. You must click the option when submitting service requests to Sign and Release your signature in order to bind the agreement. 3. Nothing in this agreement or consent changes or supersedes any existing service requests, service agreements, and contracts, and does not modify the Terms & Conditions of service. 4. You may cancel this Signature Authorization Release agreement at any time, in writing, however, all released signatures authorized prior to the cancellation of this arrangement remain in full force and are legally binding. 5. You may request copies of any signed documents that you consented to have your signature released and digitally affixed to. Signature* Δ
