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Special Basic Package*
Choose Appliance Package
Gold Package - Real Estate Special $449.00
T
Additional Options Available
A/C Over 3 tons/ per ton
Plumbing and Electrical Repair Only
Pool Pump only
Printed Circuit Boards
Second Air Conditioner
Water Heater Over 50 Gal.
Second Refrigerator - SILVER ONLY
Freezer
Sub-Total:
Tax (7.00%):
Grand Total:
Property To Be Covered
Seller`s Name*
Seller`s Email
Address 1*
Suite or Apt #
City*
State*
Choose a State
Arizona
Florida
Nevada
Texas
Zip Code*
Seller`s Phone Number
Age of Home
Salesperson Name
Buyer Information
New Owner`s Name
New Owners Phone Number
New Owner`s email
Payment Information
Payment Method*
Choose a Payment Method
I want to Mail a Check
I want to pay by Credit Card
Please make mail your check to:
Broward Factory Service
15980 S. US Highway 441
Summerfield, FL 34491
Card Brand*
Choose a Card
American Express
Master Card
Visa
Credit Card #
Expiration Date
CVV#
Billing Same as Covered Property Address?
Yes
No
Billing Address
Address Line 2
Billing City
Billing State
Choose a Billing State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Billing Zip
Confirmations - Email confirmations will be sent from Connley Davidson.
Confirmation #
BFS SalesPerson Email*
dkapellen@browardfactory.com
The rate charged for the service agreement is not subject to regulation by the Office of Insurance Regulation.
A/C CA-C056774 Florida - Plumbing CFC1430745 Florida - A/C CA-C057400
Florida -Electrical ES-0000336 Florida - A/C CA-C056778 - Florida Electrical EC13007734
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