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While you enjoy your home.

Enrollment Form

Property to be Covered
Dwelling Type:
Size: Exceeds 5,000 sq. ft.
Current owner? Yes (do not check if home is currently for sale)
Add: Guesthouse
Address:
City:
State:
Zip:
Seller:
Name:
Phone:
Buyer:
Name:
Phone:
Optional Plan Coverage

The items listed below are not covered by the standard contract but may be added for $25 each.
Select all & save $50!

Covered items include leaks caused by:

Roof flashing at chimney (to include counter flashings, pan metal, base flashing)
Roof flashing at skylight 2'X2', 2'X3' and 2'X4' only (to include, pan metal, base flashing) do not include custom sizes. (maximum three skylights)
Roof fixed skylight 2'X2', 2'X3' and 2'X4' only - do not include custom sizes. (maximum three skylights)
Roof top dead pans/crickets
Roof top dryer exhaust vent
Roof top gas furnace exhaust vent (does not include exhaust thru chimney)
Roof top gas water heater exhaust vent
Buyers Address (if different)
Address:
City:
State:
Zip:
Real Estate Office Information
Plan initiate by:
  • Buyer
  • Seller
Name:
Email:
Listing Agent
Name:
Email:
Office:
Main Office Phone:
Listing Expiration Date:
Selling Agent
Selling Agent:
Email:
Office:
Main Office Phone:
Escrow Company
Escrow Company:
Main Office Phone:
Escrow Number
Officer:
Email:
Estimated Closing Date:
Plan fee paid by:
Name:
Purchaser Type:
Payment Type:
Credit Card Information
Name on Card:
Credit Card #:
Security Code:
Expiration Date:
Extend coverage to a 3 year plan? (includes Roof Certification) -- SAVE 33%!
Total cost: $
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