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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 #
City*
State*
Choose a State
Arizona
Florida
Nevada
Texas
Zip Code*
Cell Phone #
Home Phone Number
Age of Home
Salesperson Name
Choose Your Plan
Choose your plan
Silver Plan Service Only $269.00
Gold Plan Service and Replacement $489.00
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)
Freezer
Washer & Dryer
Washer & Dryer
Freezer
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)
Sub-Total:
Tax * local county/city tax may apply (7.00%):
Total for Plan Protection:
Payment Information
Payment Method*
Choose a Payment Method
I want to Mail a Check
I want to pay by Credit Card
Please make mail your check to:
Broward Factory Service
3500 N. 28th Terrace
Hollywood, FL 33020
Card Brand*
Choose a Card
American Express
Master Card
Visa
Credit Card #
Expiration Date
CVV#
Card Holders Name
Billing Same as Covered Property Address?
Yes
No
Billing Address
Address Line 2
Billing City
Billing State
Choose a Billing 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
Billing Zip
Confirmation #
Send Confirmation Email to:*
Terms and Conditions Â
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.
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