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?
Mailing Address is for:
Seller Information
Seller Name

First NameLast Name
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
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.Format: (000) 000-0000.
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.Format: (000) 000-0000.
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
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 Buyer
BUYER; 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



2 YEAR POLICY
2 Years of LITE Coverage

$429.00



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

$99.00



SEPTIC TANK
OPTIONAL 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 BOOSTER
OPTIONAL 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 BOOSTER
OPTIONAL 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

HomeGard Lite Options ($100 deductible first three claims)