HomeGard Lite Policy Application

Home Warranty Application
Property Address To Be Covered*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address Same As Covered Address?

YesNo
Mailing Address is for:

BuyerSellerHomeowner
Seller Information
Seller Name

First NameLast Name
Mobile Phone
Please enter a valid phone number.
Seller Email
example@example.com
Listing Start Date

MonthDayYear
Date
Buyer Information
Buyer Name

First NameLast Name
Closing Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Buyer Email
example@example.com
Agent Information
Real Estate Office
Agent Name

First NameLast Name
Agent Email
example@example.com
Phone Number
Please enter a valid phone number.
DISCLOSURE: IN ADDITION TO REPRESENTING THE HOME SELLER AND/OR BUYER, THE NAMED REAL ESTATE AGENT, BROKER OR COMPANY MAY ALSO BE PERFORMING CERTAIN WARRANTY-RELATED PROCESSING, ADMINISTRATIVE, MARKETING AND OTHER SERVICES.

THE COVERAGE INCLUDES ONLY THOSE SYSTEMS, APPLIANCES AND COMPONENTS THAT WERE IN PROPER OPERATING CONDITION AT THE AGREEMENT EFFECTIVE DATE. THE FOLLOWING SYSTEMS, APPLIANCES AND COMPONENTS SHOULD BE EXCLUDED FROM COVERAGE:

YES, I WANT WARRANTY COVERAGE: APPLICANT UNDERSTANDS THE TERMS AND CONDITIONS OF WARRANTY COVERAGE AND AUTHORIZES CLOSING AGENT TO PAY REQUIRED WARRANTY FEES UPON CLOSING.
Signature*

Clear
Date*

MonthDayYear
Date
POLICY OPTIONS
HomeGard Lite Options ($100 deductible first three claims)
prevnext( X )
HomeGard LITE HOMEGARD LITE* (NO HVAC) 1 YEAR POLICY *HVAC Coverage only with HomeGard Core/Prime Policies
$429.00



HomeGard LITE BuyerBUYER; COVERAGE TO BEGIN AT CLOSING
$ Free



HomeGard LITE Seller (Up to 180 days)COVERAGE TO BEGIN AT ENROLLMENT, CONVERTS TO BUYER AT CLOSING
$70.00



WATER SOFTENER OPTIONAL COVERAGE (BUYER ONLY) - Covers one (1) domestic water softener
$99.00



SEPTIC TANKOPTIONAL COVERAGE (BUYER ONLY) - Includes jet pump, sewage ejector pump, aerobic pump, septic tank and clearing sewer line from house to septic tank
$99.00



WELL PUMP SYSTEM NO BOOSTEROPTIONAL COVERAGE (BUYER ONLY) - All components and parts of one well pump utilized as the primary source of water to the home.
$74.00



WELL PUMP WITH BOOSTEROPTIONAL COVERAGE (BUYER ONLY) - All components and parts of one well pump utilized as the primary source of water to the home.
$149.00



Total

$0.00
Should be Empty:

Home Warranty Application

Seller Information

Buyer Information

Agent Information

POLICY OPTIONS