First Name *Last Name * Email *Phone * Street Address *City *---AtlantisBoca RatonBoynton BeachBriny BreezesCloud LakeDelray BeachDeerfield BeachGlen RidgeGolfGreenacresGulf StreamHaverhillHighland BeachHypoluxoJuno BeachLake Clarke ShoresLake ParkLake WorthLantanaLoxahatchee GrovesManalapanMangonia ParkNorth Palm BeachOcean RidgePalm BeachPalm Beach GardensPalm Beach ShoresPalm SpringsRiviera BeachRoyal Palm BeachSouth Palm BeachWellingtonWest Palm BeachWestlake Zip Code *Community---ABERDEENAVALON ESTATESBELLAGGIOBENT TREE VILLASBOCA POINTEBUENA VIDACANYON ISLESCANYON LAKESCASCADE LAKESCENTURY VILLAGECORAL LAKESFLORAL LAKESFOUR SEASONSGLENEAGLESGREYSTONEGROVE ISLEHUNTINGTON LAKESHUNTINGTON POINTEHUNTINGTON TOWERSINDIAN SPRINGSKINGS POINTLAKERIDGE GREENMAJESTIC ISLESMIZNER FALLSPALM CHASEPALM ISLESPINE TREEPLATINAPOLO TRACEPONTE VECCHIOPONTE VECCHIO WESTRAINBERRY BAYRIVER BRIDGESANDHURSTSAN MARCOSUN VALLEY EASTTHE BRIDGESTHE CASCADESTHE CLUB AT INDIAN LAKESTHE GROVETHE LAKES OF DELRAYTIVOLI LAKESTIVOLI RESERVETUSCANY BAYVALENCIA BAYVALENCIA COVEVALENCIA FALLSVALENCIA ISLESVALENCIA LAKESVALENCIA PALMSVALENCIA POINTEVALENCIA RESERVEVALENCIA SHORESVENETIAN ISLESVERONA LAKESVILLA BORGHESEVILLAGGIOVILLAGGIO RESERVEVIZCAYAOTHER NEXT HOME SPECIFICATIONS Starting Price: $370 - $25 [New Member Discount] BATHROOMS *UP TO 3.5 BATHROOMS ARE COVERED---3.5 BATHROOMS OR LESS4 BATHROOMS - Plus $255 BATHROOMS - Plus $506 BATHROOMS - Plus $757 BATHROOMS - Plus $100 SIZE OF WATER HEATER *UP TO 50 GALLONS IS COVERED---50 GALLONS OR LESS65 GALLONS - Plus $2080 GALLONS - Plus $30 REFRIGERATOR 1 REFRIGERATOR IS COVERED---1 REFRIGERATOR2 REFRIGERATORS - Plus $253 REFRIGERATORS - Plus $50 HOT WATER HEATER *1 HOT WATER HEATER IS COVERED---1 HOT WATER HEATER2 HOT WATER HEATERS - Plus $253 HOT WATER HEATERS - Plus $50 All information provided must be accurate. Repairs will not be made for additional appliances not specifically listed. BACKNEXT The following are “Cost Saving Options” that may be a useful alternative way for you to save money. Only you can decide if these are beneficial to your particular situation. No Changes after 30 days. #1 DEDUCTIBLE OPTION *DEDUCTIBLE OPTION - Deduct $100.00 from the price. You pay $45.00 for each Service Call to your home. This option may be good for those who feel they will require little service or have newer appliances in their home, but want the security of a Warranty Plan to avoid major expenses. Deductible payment is made directly to the technician at time of service.---STANDARD PLAN - NO SERVICE CALL FEEPAY EACH SERVICE CALL - DEDUCT $100 #2 NO REPLACEMENT OPTION *Deduct $25.00 from the price. We will cover “Repairs”, but not “Replacement” This option may be good for those with newer homes, recent replacements, or newer appliances. No Replacement.---KEEP REPLACEMENT OPTIONNO REPLACEMENT OPTION - DEDUCT $25 #3 NO AIR CONDITIONING OPTION *Deduct $50 from the price. Air Conditioning service will not be included. This may be a good option when a new system has been recently installed.---KEEP AIR CONDITIONING OPTIONNO AIR CONDITIONING OPTION - DEDUCT $50 #4 ELECTRICAL/PLUMBING OPTION *Deduct $25 for Electrical and/or $45 for Plumbing if you do not want them covered.---KEEP PLUMBING/ELECTRICALNO ELECTRICAL OPTION - DEDUCT $25NO PLUMBING OPTION - DEDUCT $45NO PLUMBING & NO ELECTRICAL - DEDUCT $70 #5 NEW APPLIANCE OPTION *Deduct $25 from the price for each of the following that you do not want covered. THREE MAXIMUM: Microwave, Dishwasher, Refrigerator, Garbage Disposal, Stove/Oven, Washer, Dryer, Hot Water Heater will not be covered by your warranty. ---KEEP NEW APPLIANCE OPTIONREMOVE 1 APPLIANCEREMOVE 2 APPLIANCESREMOVE 3 APPLIANCES APPLIANCES If you chose to remove appliances from option 5, please specify up to 3 appliances. Total (Tax Included) By entering my information and submitting for a free quote, I am providing express consent to be contacted via email or phone, including my wireless phone number, regarding product and servicing information, even if it is registered on a federal, state, or corporate do not call list. I am not required to provide this consent in order to obtain goods or services from Quality Service. If my area is not covered, I may be referred to alternate trusted provider.