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BFS Arizona and Nevada Order Form (buyers only)
How did you hear about BFS Home Warranty?
Mailer
Realtor
Just surfed in
Friend or Neighbor
Other
E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
*E-Mail:
Real Estate Transaction (Buyer Coverage only)
Realty Office
Agent`s Name
Address Line 1
Realty Office Address
Address Line 2:
Apt. or Suite No.
City:
State:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Phone:
Input as: 000-000-0000
Fax:
Input as: 000-000-0000
Closing Company
Closing Agent
Closing Date
Title Company
Title Co. Phone Number:
Input as: 000-000-0000
Title Co. Fax:
Input as: 000-000-0000
YOUR BASIC COVERAGE INCLUDES: 2 AC Units, Heating, Electric, Trash Compactor,
Dishwasher, Disposal, Oven/Range, Built-in Microwave, Water Heater, and Plumbing.
*Home Warranty Select One:
Choose Home Warranty Select One
1-Year Single Family Home $329.00
1-Year Condo/Townhouse $299.00
1-Year Multi-Unit Duplex $525.00
1-Year Multi-Unit Triplex $675.00
1-Year Multi-Unit Fourplex $775.00
Available Options
NO DEDUCTIBLE
No Deductible Option - Unlimited Number of Service Calls
13 SEER AC option
Choose: 13 SEER AC upgrade INCLUDED
13-SEER AC upgrade INCLUDED $.00
Replacement Upgrade 1AC unit-Required by the Dept of Energy $49.00
Replacement Upgrade 2AC units-Required by the Dept of Energy $98.00
Add Air Conditioner
Additional 3rd Air Conditioner
Add Pool/Spa
Pool / Spa Coverage
Circuit/Electronic Boards
Circuit/Electronic Boards Coverage
Add Refrigerator/Ice Maker
Refrigerator/Ice Maker/Ice and Water Dispenser
Add Washer/Dryer
Washer/ Dryer Coverage
Add Garage Door Opener
Garage Door Opener Coverage
Add Stoppage
Stoppage Coverage
Coverage Total:
Property to be covered
*First Name:
First name of homeowner
*Last Name:
Last name of homeowner
*Property Address Line 1:
Address of property covered
Property Address Line 2:
Apt. or Suite No.
*City:
*State:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*Zip Code:
Phone:
Customer`s Billing Information
*First Name:
Same name as on your card
*Last Name:
*Customer`s Address:
Where your statement is mailed
Address Line 2:
Apt. or Suite No.
*City:
*State:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*Zip Code:
Phone:
Homeowner`s Credit/Debit Card Information (Optional for real estate transaction)
or mail your check to: B.F.S. • ATTN. Contract Department • 3500 N 28 Terrace • Hollywood, FL 33020
Name on Credit Card
Card Number:
No dashes or spaces please
Expiration Month:
Month
January
February
March
April
May
June
July
August
September
October
November
December
From your card
Expiration Year:
Year
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
From your card
Card Brand:
Choose a Card
American Express
Master Card
Visa
CVV2:
Card Security Code
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