EPPERSON Comfort Club
Membership Application
First Name
Last Name
Maintenance Address
Street Address Line 2
Street Address Line 2
City
State / Province
Postal / Zip Code
Billing Address
Billing Address
Street Address Line 2
City
State
Postal / Zip Code
Email Address
example@example.com
Phone Number
Plan Selection
Membership Level & Quantity of Systems
Gold Plan
$30/mo or $330/yr + Each Additional system ($20/mo or $220/yr)
Number of Additional Gold Plan Systems
Additional Gold Plan Systems Cost Monthly/Yearly
Total Gold Plan Monthly/Yearly amount including additional systems
Payment Selection (choose one)
Monthly
Yearly
Silver Plan
$25/mo or $275/yr + Each Additional system ($15/mo or $165/yr)
Number of Additional Silver Plan Systems
Additional Silver Plan Systems Cost Monthly/Yearly
Total Silver Plan Monthly/Yearly amount including additional systems
Payment Selection (choose one)
Monthly
Yearly
Bronze Plan
$20/mo or $220/yr + Each Additional system ($10/mo or $110/yr)
Number of Additional Bronze Plan Systems
Additional Bronze Plan Systems Cost Monthly/Yearly
Total Bronze Plan Monthly/Yearly amount including additional systems
Payment Selection (choose one)
Monthly
Yearly
System(s) Information
System #1 Size
Please Select
1.5 TON
2 TON
2.5 TON
3 TON
3.5 TON
4 TON
5 TON
System #1 Outdoor Unit Brand
Please Select
Trane
Goodman
Carrier
Bryant
Ameristar
RunTru
Lennox
Daikin
GE
Other
System #1 Outdoor Unit Model Number
System #1 Outdoor Unit Serial Number
System #1 Outdoor Unit Age
Please Select
0-5 Years
5-10 Years
10-15 Years
15-20 Years
20+ Years
System #1 Indoor Unit Brand
Please Select
Trane
Goodman
Carrier
Bryant
Ameristar
RunTru
Lennox
Daikin
GE
System #1 Indoor Unit Model Number
System #1 Indoor Unit Serial Number
System #1 Indoor Unit Age
Please Select
0-5 Years
5-10 Years
10-15 Years
15-20 Years
20+ Years
System #1 Filter Sizes/Qty
System #2 Size
Please Select
1.5 TON
2 TON
2.5 TON
3 TON
3.5 TON
4 TON
5 TON
System #2 Outdoor Unit Brand
Please Select
Trane
Goodman
Carrier
Bryant
Ameristar
RunTru
Lennox
Daikin
GE
Other
System #2 Outdoor Unit Model Number
System #2 Outdoor Unit Serial Number
System #2 Outdoor Unit Age
Please Select
0-5 Years
5-10 Years
10-15 Years
15-20 Years
20+ Years
System #2 Indoor Unit Brand
Please Select
Trane
Goodman
Carrier
Bryant
Ameristar
RunTru
Lennox
Daikin
GE
System #2 Indoor Unit Model Number
System #2 Indoor Unit Serial Number
System #2 Indoor Unit Age
Please Select
0-5 Years
5-10 Years
10-15 Years
15-20 Years
20+ Years
System #2 Filter Sizes/Qty
System #3 Size
Please Select
1.5 TON
2 TON
2.5 TON
3 TON
3.5 TON
4 TON
5 TON
System #3 Outdoor Unit Brand
Please Select
Trane
Goodman
Carrier
Bryant
Ameristar
RunTru
Lennox
Daikin
GE
Other
System #3 Outdoor Unit Model Number
System #3 Outdoor Unit Serial Number
System #3 Outdoor Unit Age
Please Select
0-5 Years
5-10 Years
10-15 Years
15-20 Years
20+ Years
System #3 Indoor Unit Brand
Please Select
Trane
Goodman
Carrier
Bryant
Ameristar
RunTru
Lennox
Daikin
GE
Other
System #3 Indoor Unit Model Number
System #3 Indoor Unit Serial Number
System #3 Indoor Unit Age
Please Select
0-5 Years
5-10 Years
10-15 Years
15-20 Years
20+ Years
System #3 Filter Sizes/Qty
System #4 Size
Please Select
1.5 TON
2 TON
2.5 TON
3 TON
3.5 TON
4 TON
5 TON
System #4 Outdoor Unit Brand
Please Select
Trane
Goodman
Carrier
Bryant
Ameristar
RunTru
Lennox
Daikin
GE
Other
System #4 Outdoor Unit Model Number
System #4 Outdoor Unit Serial Number
System #4 Outdoor Unit Age
Please Select
0-5 Years
5-10 Years
10-15 Years
15-20 Years
20+ Years
System #4 Indoor Unit Brand
Please Select
Trane
Goodman
Carrier
Bryant
Ameristar
RunTru
Lennox
Daikin
GE
Other
System #4 Indoor Unit Model Number
System #4 Indoor Unit Serial Number
System #4 Indoor Unit Age
Please Select
0-5 Years
5-10 Years
10-15 Years
15-20 Years
20+ Years
System #4 Filter Sizes/Qty
Terms and Conditions
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This agreement will remain in effect unless cancelled by customer or Epperson, Inc.
Customer will be notified at least 30 days prior to renewal of any price increase or plan changes.
If automatic payment is declined, customer must provide updated credit card information within 7 days for plan benefits to continue.
Epperson, Inc may contact customer to schedule inspection to verify correct air filters and quantities are on site.
This agreement covers (1) heating and cooling system unless specified on the agreement. Customer must furnish the correct size and quantity of air filters needed. If filters are not furnished by customer, filters will not be replaced during maintenance.
This agreement does not cover refrigerant leaks, water leaks, condensate clogs, drain clogs, ductwork condensation, water damage or damage caused by condensate leaks or excessive dampness at customer's property.
Epperson shall not be liable for customer's failure to use ordinary care in the operation of the heating and cooling equipment including but not limited to failure to turn on main switch, circuit breakers or any other cause unrelated to normal operation of equipment, and failure to perform routine maintenance (necessary air filter changes).
If, when due to age, condition or obsolescense, it is no longer practical to continue serviceing the customer's equipment, Epperson has the right to rescind this agreement.
This Agreement applies to "Maintenance/Inspection" only. Parts and labor needed for repairs will be billed separately.
This agreement is non-refundable.
Epperson, Inc may decline service if conditions present a hazard, create potential danger, or health risk to our technicians.
Epperson, Inc reserves the right to terminate this agreement should the customer fail to provide a safe and reasonably clean area in which to work.
This agreement applies to residential single-family residence only. Includes: Residential packaged and unitary split systems only.
New Equipment Credits: Plan must consecutively remain active and be current for accrued credit to be valid. Any lapse in coverage or cancellation will cause the accrued credits to be voided. Credit will not be accrued until after one year has been paid in full or at the time of renewal.
New Equipment Credits: credit will be accrued for each HVAC system covered under the selected plan. Credit accrued for multiple systems can be combined and used toward the purchase of a single system.
Discounts associated with the Gold and Silver plans apply to service calls and repairs only.
Acceptance of Maintenance Agreement
Customer Name
Signature
Date
/
Month
/
Day
Year
Date
Payment Information
Card Type
VISA
MasterCard
American Express
Discover
Payor Name
Monthly Payment Amount
Day of Scheduled Reoccurring Payment
Month of Scheduled Reoccurring Payment
Card Holder Signature
Signature Date
/
Month
/
Day
Year
Date
Submit
Should be Empty: