Common Contracts
1 similar Product Warranty Agreement contracts
Buyer’s Choice, Inc.Product Warranty Agreement • March 25th, 2013
INS.100 A.C.I.N.20 C.I.N.2001 Name Telephone Agreement No. 128- Street Address Apt. # Male Female□ □ City State Zip Date of Birth Social Security Number Year Make Model VIN Number Odometer Reading Vehicle Purchase Price Date of Purchase Vendor Name Vendor I.D. Telephone Address City State Zip Lienholder Name Telephone Address City State Zip STANDARD MID AMERICA 2013Terms: Terms:□ 3 months/3,000 miles □ 18 months / 18,000 miles□ 24 months / 24,000 milesSurcharge: □ 36 months / 36,000 miles□ A/C System □ 48 months/48,000 miles□ Turbo/Supercharger□ Enhanced Seals and Gaskets Surcharge:□ 4x4/All Wheel Vehicles A/C System (Included)□ Class 5 Vehicles Turbo/Supercharger (Included)□ Diesel □ Enhanced Seals and Gaskets□ 1 Ton Trucks □ 4x4/All Wheel Vehicles□ Enhanced Labor Rate □ Class 5 Vehicles□ Diesel□ 1 Ton Trucks□ Enhanced Labor Rate Vehicle Class # Plan Amount $ Plan Code # Surcharge $ Deductible $ Total $ I have read, understand and accept the terms of this product warranty. Date Ow
