Agreement Number:Service Agreement • March 31st, 2025
AGREEMENT HOLDER INFORMATION NAME PHONE ADDRESS (Complete only if Holder’s mailing address is different from the Covered Property Address) CITY STATE ZIP COVERED PROPERTY ADDRESS ADDRESS CITY STATE ZIP AGREEMENT INFORMATION AGREEMENT TERM IN MONTHS month(s) AGREEMENT PURCHASE DATE AGREEMENT EFFECTIVE DATE AGREEMENT RENEWAL DATE (ifapplicable) AGREEMENT EXPIRATION DATE SERVICE CALL FEE$75 AGREEMENT PURCHASE PRICE COVERAGE SELECTED Coverage Options:❑ [DELUXE COVERAGE PLAN – includes the following:]▪ [Built-In Microwave] ▪ [Ceiling Fans]▪ [Dishwasher] ▪ [Doorbell System]▪ [Garbage Disposal] ▪ [Kitchen Exhaust Fan]▪ [Kitchen Refrigerator] ▪ [Internal Electrical(excludes ice maker) System]▪ [Range/Oven/Cooktop]▪ [Clothes Washer]▪ [Clothes Dryer]▪ [Central Air Conditioner]▪ [Central Heating System]▪ [Water Heater][Optional Coverages – additional charges apply]❑ [Free-Standing Freezer] ❑ [Spa] ❑ [Garage Door Opener] ❑ [Wine Cooler]❑ [Programmable Thermostat] ❑ [Swimming Pool] ❑ [Additional A
Agreement Number:Service Agreement • March 31st, 2025
AGREEMENT HOLDER INFORMATION NAME PHONE ADDRESS (Complete only if Holder’s mailing address is different from the Covered Property Address) CITY STATE ZIP COVERED PROPERTY ADDRESS ADDRESS CITY STATE ZIP AGREEMENT INFORMATION AGREEMENT TERM IN MONTHS month(s) AGREEMENT PURCHASE DATE AGREEMENT EFFECTIVE DATE AGREEMENT RENEWAL DATE (ifapplicable) AGREEMENT EXPIRATION DATE SERVICE CALL FEE$75 AGREEMENT PURCHASE PRICE COVERAGE SELECTED Coverage Options:❑ [DELUXE COVERAGE PLAN – includes the following:]▪ [Built-In Microwave] ▪ [Ceiling Fans]▪ [Dishwasher] ▪ [Doorbell System]▪ [Garbage Disposal] ▪ [Kitchen Exhaust Fan]▪ [Kitchen Refrigerator] ▪ [Internal Electrical(excludes ice maker) System]▪ [Range/Oven/Cooktop]▪ [Clothes Washer]▪ [Clothes Dryer]▪ [Central Air Conditioner]▪ [Central Heating System]▪ [Water Heater][Optional Coverages – additional charges apply]❑ [Free-Standing Freezer] ❑ [Spa] ❑ [Garage Door Opener] ❑ [Wine Cooler]❑ [Programmable Thermostat] ❑ [Swimming Pool] ❑ [Additional A