13-Month Home Warranty We’ve Got You Covered Home Warranty of America™, Inc. Dept. 3344, Carol Stream, IL 60132-3344 P 888-492-7359 F 888-492-7360 HWAHomeWarranty.com If placing your order by phone or online, have information ready. Applicant Information Applicant first and last name Covered property address City Mailing Address (if different) City Phone Order Date Closing Information (if available) Closing company Phone # Buyer’s Coverage Levels Trade Call Fee per occurrence or actual cost, whichever is less Covered Items* Unknown Insufficient Maintenance Unknown Pre-Existing Conditions Heating System/Furnace Air Conditioning System/Cooler Ductwork Plumbing System Stoppages/Clogs Permanent Sump Pump Water Heater Including Tankless Whirlpool Bath Tub Electrical System Ceiling Fans and Exhaust Fans Doorbells, Burglar & Fire Alarm Systems Central Vacuum Dishwasher Garbage Disposal Built-In Microwave Range/Oven/Cooktop Trash Compactor Garage Door Opener Kitchen Refrigerator w/ Ice Maker Washer/Dryer Package Telephone Line Coverage Re-Key SEER/R-410A Modifications Premium Coverage OrangePlus Premium Coverage Includes coverage for over 30 items traditionally not covered by basic home warranty plans: • Sediment in the water heater • Plumbing – Fixtures, faucets, shower heads, stoppages/clogs • Plus over 25 more items! Plan Cost Select coverage level: r Gold $475 r Platinum $520 r Diamond $590 Townhome/Condo /Mobile Home: r Gold $455 r Platinum $490 r Diamond $560 *See contract for specific coverage on components and parts The fee for this warranty is to be paid at closing and includes all fees payable to HWATM ©2017 Home Warranty of America, Inc. Total Optional Seller’s Coverage Total Optional Buyer’s Coverage Grand Total Coverage $ __________________________________________________________ $ __________________________________________________________ $ __________________________________________________________ for service and plan administration per the plan’s service agreement. This Home Warranty is subject to terms and conditions. FL9 2017 BRO State State Email Zip Zip Phone/Web Confirmation # Closing agent Closing # Gold $475 $75 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 Platinum Diamond $520 $590 $100 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 $100 Plan Accept/Decline I have been offered a Home Warranty of America home warranty for my home and understand the terms/conditions of coverage. r Buyer’s Coverage date of closing _____________________________________________________r Seller’s Coverage r Decline benefits of this coverage. Signature _______________________________________________________________________ Waiver Purchase of this coverage is not mandatory. Applicant has reviewed the home warranty plan and hereby declines coverage. Applicant agrees to hold the real estate broker and agent harmless in the event of a subsequent mechanical failure which otherwise would have been covered under the warranty plan. Real Estate Agent Information Initiating Agent Name Whom do you represent? r Buyer r Seller Company Name Phone Email Other Party's Agent Optional Coverage Seller’s Coverage r $60 Optional Seller’s Coverage Buyer’s Coverage Add on to All Plans: r $70 GreenPlus • Covered system or appliance will be replaced with an ENERGY STAR qualified product • Dishwasher, Refrigerator and Clothes Washer • Heating System replacement with 90% efficiency model • Water Heater replacement with Tankless Water Heater r $49 Subterranean Termite Treatment r $50 Freezer—Stand Alone r $35 2nd Refrigerator r $80 External Water Line Repair r $195 External Water Line + Sewer & Septic Line Repair r $195 Pool/Spa Combo r $195 Additional Pool or Spa r $345 Salt Water Pool (Includes Pool/Spa Combo) r $100 Well Pump r $75 Septic Tank Pumping r $75 Septic System/Sewage Ejector Pump Add on to Gold or Platinum: r $75 OrangePlus Add on to Gold: r $85 Washer/Dryer Package r $70 Premium Coverage OrangePlus Coverage • Code Violations and permits up to $250 • Unknown improperly matched and/or installed systems • Increases Professional Series appliances up to $2,500 • Increases Toilet replacement up to $600 • Removal of Defective Equipment
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