Multi-Coverage Protection Service ContractMulti-Coverage Protection Service Contract • October 27th, 2021
CUSTOMER INFORMATION Last Name First Name Middle Initial Street Address Apt. City State ZIP Code Phone Number Email CO-SIGNING CUSTOMER INFORMATION Last Name First Name Middle Initial Street Address Apt. City State ZIP Code Phone Number Email COVERED VEHICLE INFORMATION Year Make Model Vehicle Identification Number (VIN) Current Odometer Reading Vehicle Purchase Price $ SELLER INFORMATION Name Seller Number Street Address City State ZIP Code Phone Number LENDER INFORMATION Name Street Address City State ZIP Code MULTI-COVERAGE PROTECTION AGREEMENT INFORMATION Agreement Term (in months) Agreement Purchase Date Agreement Retail Price $ Agreement Effective Date Date of Delivery of Covered Vehicle and key(s) to Customer MULTI-COVERAGE PROTECTION INDIVIDUAL PROTECTION OPTIONS Platinum Protection Package: Tire & Wheel Protection (includes cosmetic coverage for wheels), Dent Protection, Win
