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Lauderdale West Special Warranty Application
Silver Plan covers all Functional Parts & Labor
Gold Plan covers Repair & Replacement on all covered items
Gold Plan covers items listed above for Service AND Replacement.

Property To Be Covered
Owner`s Name*

Owner`s Email

Address 1*

Suite or Apt #

City*

State*

Zip Code*

Cell Phone #

Home Phone Number

Age of Home

Choose Your Plan
Plumbing & Electrical
Additional EXTENDED Plumbing
Circuit Boards / Touchpads
Additional A/C Ton
Additional A/C Ton
Additional 10 Gallons on Water Heater
Additional 10 Gallons on Water Heater
A/C Check-up
Second AC Unit
Second AC Unit
Second Water Heater
Second Water Heater
Lighting Ballast
 
Sub-Total:
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
2860 West State Rd 84 Suite 101
Ft Lauderdale, FL 33312
Card Brand*

Credit Card #

Expiration Date

CVV#


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
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