HomeGard Core 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 CORE Options ($75 deductible first three claims)
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HomeGard COREHOMEGARD CORE POLICY
$629.00



HomeGard CORE BUYERBUYER; COVERAGE TO BEGIN AT CLOSING
$ Free



HomeGard CORE SELLER (Up to 180 days)COVERAGE TO BEGIN AT ENROLLMENT, CONVERTS TO BUYER AT CLOSING
$ Free



OVER 5000 SQ. FT. COVERAGE OPTIONFor policies with a property OVER 5000 sq. ft.
$500.00



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



WET BAR REFRIGERATOR/ WINE COOLER/ ICE MAKER PACKAGEWet Bar Refrigerator (up to 16 cubic ft), Built-In Wine Cooler (30-bottle maximum), freestanding icemaker, additional refrigerator. All components that affect the cooling operation of the unit (up to a combined total of four appliances) including compressor, thermostat, condenser coil, evaporator, defrost system, motor and fill valve
$29.00



MULTI-UNIT PRICING (QUANTITY PER UNIT)This option is for a duplex, triplex, quadplex, mother-in-law suite, coach house, additional kitchen.
$ Free Quantity



Total

$0.00
Should be Empty:

Home Warranty Application

Seller Information

Buyer Information

Agent Information

POLICY OPTIONS