GSS Form

Are you a buyer or seller?*

Seller
Home Address of Warranty Coverage*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Agent Name*

First NameLast Name
Payment Information

for Seller Coverage, No payment is required until home is sold
Who is Paying*

BuyerSeller
Method of Payment*

Closing ProceedsCheckBank TransferCredit Card
If being paid by Bank Transfer or Credit Card, please provide us an email address. You will be emailed a link to pay online, or call our office at (586) 840-0484.
* See "Service Contract Terms" & Warranty Seller & Optional Coverage terms ** These items have age restrictions unless Premium Warranty is purchased + Optional items included with Premium Warranty

Terms and Conditions
List Date*

MonthDayYear
Date
Seller represents that all the covered items are in good working condition. Items that are not in good working condition at the time of listing will NOT be covered. Please list any items that are not in good working condition and/or defective:
Seller agrees to and/or authorizes broker and/or home inspector to release a copy of the Seller's Disclosure Statement, Listing Agreement, and any Pre-Inspection Reports to validate information. Seller understands that this is a limited service agreement and has read the list of covered items and the Terms of Coverage. Seller understands and mutually agrees to the following: a) listing coverage is free to the seller(s) b) Seller(s) are contractually obligated to purchase this Home Protection Plan at closing if property closes within 18 months of seller coverage. Seller coverage for the listing and sale period starts the date the application is received and accepted by Gold Shield Services and continues until the expiration of the initial listing period (up to 180 days) or until close of sale or listing cancellation (whichever is first). Tenant occupied homes are not available for seller coverage.*

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Click "Review Answers" to continue and activate your coverage.
Should be Empty:

Buyer

Coverage

Payment Information

Seller

Payment Information