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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 1Realty Office Address
Address Line 2:Apt. or Suite No.
City:
State:
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:
Available Options
NO DEDUCTIBLE
No Deductible Option - Unlimited Number of Service Calls
13 SEER AC option
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:
*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:
*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:From your card
Expiration Year:From your card
Card Brand:
CVV2:Card Security Code
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