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Additional Options Available
Washer / Dryer
Second Refrigerator
Freezer
Second Air Conditioner
Third Air Conditioner
Plumbing and Electrical (Minor Only)
Printed Circuit Boards
AC and Water Heater Tune Ups
A/c Tune Up 1x yr 1 AC unit
A/c Tune Up 2x yr 1 AC unit
Add on additional A/C unit - enter quantity
Water Heater Tune Up 1x Yr
Water Heater Tune Up 2x Yr
Additional Water Heater
Sub-Total:
Tax * local county/city tax may apply (7.00%):
Grand Total:
Property To Be Covered
Name*

Email

Address 1*

Suite or Apt #

City*

State*

Zip Code*

Phone Number

Age of Home

Payment Information
Payment Method*

Please make mail your check to:
Broward Factory Service
6240 Arc Way
Ft Myers, FL 33966
Full Name on Credit Card

Card Brand*

Credit Card #

Expiration Date

CVV#


Billing Address

Address Line 2

Billing City

Billing State

Billing Zip

Confirmations - Email
Confirmation #

Email Address for Confirmation*

 
The rate charged for the service agreement is not subject to regulation by the Office of Insurance Regulation.
Florida - A/C CA-C056778 Florida - A/C CA-C057400 Florida- Plumbing CFC1430745
Florida -Electrical ES-0000336 - Florida Electrical EC13007734
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