BFS Texas Order Form (buyers only)

BFS Texas Order Form (buyers only)
How did you hear about BFS Home Warranty?
 Realtor  Mailer  Just surfed in  Friend/Neighbor  Other 
Customer E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
*E-Mail:  
Real Estate Transaction (Buyer Coverage only)
Realty Office  
Agent`s Name  
Address Line 1   Realty Office Address
Address Line 2:   Apt. or Suite No.
City:  
State:  
Zip Code:  
Phone:   Format 000-000-0000
Fax:   Format 000-000-0000
Closing Company  
Closing Agent  
Closing Date   
Title Co. Phone Number:   Format 000-000-0000
Title Co. Fax:   Format 000-000-0000
Basic Coverage with $55.00 Service Call Fee (deductible) includes: 2 AC Units, Heating, Electric, Trash Compactor,
Dishwasher, Disposal, Oven/Range, Built-in Microwave, Water Heater, and Plumbing.
*Home Warranty Select One:  
Available Options
NO DEDUCTIBLE    No Deductible Option - Unlimited Number of Service Calls $150.00  
13 SEER AC INCLUDED!  
Add Air Conditioner    Additional 3rd Air Conditioner $99.00  
Add Pool/Spa    Pool / Spa Coverage $160.00  
Circuit/Electronic Boards    Circuit/Electronic Boards Coverage $75.00  
Add Refrigerator/Ice Maker    Refrigerator/Ice Maker/Ice and Water Dispenser $50.00  
Add Washer/Dryer    Washer/ Dryer Coverage $80.00  
Add Garage Door Opener    Garage Door Opener Coverage $25.00  
Add Stoppage    Stoppage Coverage $25.00  
Coverage Total:  
Property to be covered
*First Name:   First name of homeowner
*Last Name:   Last name of homeowner
*Property Address Line 1:   Address of property covered
Property Address Line 2:   Apt. or Suite No.
*City:  
*State:  
*Zip Code:  
Phone:  
Customer`s Mailing Address
*First Name:  
*Last Name:  
*Customer`s Address:  
Address Line 2:   Apt. or Suite No.
*City:  
*State:  
*Zip Code:  
Phone:  
Homeowner`s Credit/Debit Card Information (Optional for real estate transaction)
or mail your check to: B.F.S. • ATTN. Contract Department • 3500 N 28 Terrace • Hollywood, FL 33020
Name on Credit Card  
Card Number:   No dashes or spaces please
Expiration Month:   From your card
Expiration Year:   From your card
Card Brand:  
CVV2:   Card Security Code
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