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Application for Silver/ Gold coverage

$269.00 * Silver Plan includes parts & labor for all functional parts for the following items:
A/C unit (up to 5 Tons) Heating
Water Heater (up to 50 Gallons) Thermostat
Refrigerator Ice Maker Oven/Range
DishWasher Garbage Disposal

Upgrade to Gold! Gold Plan $489.00
Gold Plan covers items listed above for Service AND Replacement.
Gold Plan also includes the Standard SEER upgrade.

*Terms and Conditions apply.
Inspection report of covered products may be required.
BFS reserves the right to determine pre-existing conditions on covered products.

Property To Be Covered
Owner`s Name*

Owner`s Email

Address 1*

Suite or Apt #



Zip Code*

Cell Phone #

Home Phone Number

Age of Home

Salesperson Name

Choose Your Plan
Additional options available :
Second A/C up to 5 Tons
Second A/C up to 5 Tons
A/C extra Tons / 15.00 per ton
A/C extra Tons / 25.00 per Ton
Second Refrigerator
Second Refrigerator
Second Water Heater (up to 50 Gals)
Second Water Heater (up to 50 glas)
Extra Water Heater Gallons / 15.00 per 10 gallons
Extra Water Heater Gallons / 30.00 per 10 gallons
Double Oven
Double Oven
Door Seals and Gaskets (Silver Only)
Washer & Dryer
Washer & Dryer
A/C & Heat Emergency Service
A/C & Heat Emergency Service
Built in Microwave
Built in Microwave
Plumbing & Electric (Silver only )
Pool Pump Motor (Silver only )
Printed Circuit Boards & Touch Pads (Silver only)
Tax * local county/city tax may apply (7.00%):
Total for Plan Protection:
Payment Information
Payment Method*

Please make mail your check to:
Broward Factory Service
3500 N. 28th Terrace
Hollywood, FL 33020
Card Brand*

Credit Card #

Expiration Date


Card Holders Name

Billing Address

Address Line 2

Billing City

Billing State

Billing Zip

Confirmation #

Send Confirmation Email to:*


Florida - A/C CA-C056778 Florida - A/C CA-C057400 Florida- Plumbing CFC1430745
Florida -Electrical ES-0000336 - Florida Electrical EC13007734
Nevada A/C 0040504, 0081113 Nevada Water Heater 0046467 Nevada Plumbing 0081114
Texas Plumbing M-44053 Texas A/C TACLB20853E, TACLB33262E, TACLB98475E
Arizona A/C 280095,279402 Arizona Plumbing 289307
Notice to TX customers: you, the buyer, have other rights and remedies under the Texas deceptive trade practices consumer protection act which are in addition to any remedy which may be available under this contract. For more information concerning your rights, contact the consumer protection division of the attorney general`s office, your local district or county attorney or the attorney of your choice. Prices subject to change without notice.

Notice to NV customers: If you are not satisfied with the way BFS has handled your claim, you may contact our corporate office at 954-920-9774. If satisfaction of the claim is not provided, you may contact the Nevada Division of Insurance at 1-888-872-3234.

The rate charged for the service agreement is not subject to regulation by the Office of Insurance Regulation.