Star Plan Warranty Application

Please complete the form below and submit. (real estate transaction pricing only)

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Warranty Information
*Required
Warranty Purchaser		Seller   Buyer
Warranty Plan (not for seller)		3 Star 4 Star 5 Star
Optional Coverage (not available on seller plans)
Options 3 Star 4 Star 5 Star                   Seller Coverage $59 $59 $59   Stellar Package $ 50 $ 50 $ 50   Roof Leak Repair $ 75 $ 75 Covered   Central Vacuum $ 25 Covered Covered       Garage Door Opener $ 25 $25 $25       Termite Protection $ 85 Covered Covered       Well Pump $ 75 $ 75 $ 75       Washer/Dryer $ 50 $ 50 Covered       Septic $ 50 $ 50 $ 50       Swimming Pool / Spa $ 150 $ 150 $ 150       Stoppages $ 25 Covered Covered
Owner Information
Full Name*
Phone Number*
Property Address*
City*
State*		FL
Zip*
Property Information
Year Home was built*
Sq. feet
Type of Construction
Broker Information
GHW Broker #
Broker Firm Name*
Broker Firm Phone*
Agent's Name*
Agent's Phone*
E-mail Address
Closing Information
Closing Company*
Closing Date*
File No.
Phone*
Fax Number		(facilitates faster invoicing)
Billing Information
Pay at Closing
Send In Check
Pay by Credit Card
Please select Credit Card Type VISA MASTERCARD DISCOVER
*Required if paying by Credit Card
Name on Credit Card *
Credit Card Number *
Credit Card Exp.
CSV * Find My CSV		(May be 3 or 4 numbers on the back of your credit card)
Billing Address *
Billing City *
Billing State *
Billing Zip *
Comments
By submitting this form I warrant, to the best of my knowledge, that all systems are in good working order and I accept coverage.
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