Lane's Protection Plan Application

LANE'S APPLIANCE PROTECTION PLAN

Online Application
Select a plan*
Select a price tier*
-The Gold Price Tier has no deductiable. -The Silver Price tier is a 20% savings and has a $60 deductiable per appliance claim.
Would you like to add any additional appliances?
*Must have Kitchen Plan or Whole Home to add additional appliances
Select a billing cycle*
Total amount to be billed Monthly
Total amount to be billed Yearly

Lets get some basic information.
Address*
Please enter the address were the appliances are located.
Address Line 2
City*
Zip Code*
Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Has a Lane's representative recently discussed the protection plan with you?
What was the name of the representative?

Tell us which appliances you want to have listed on the plan.

If you cannot find the Model# and/or Serial# you can leave those fields blank. You also have the option to take a photo of the model and serial tag.
Washer
Washer Model Tag (optional)
Dryer
Dryer Model Tag (optional)
1st Appliance
1st appliance Model Tag (optional)
2nd Appliance
2nd appliance Model Tag (optional)
3rd Appliance
3nd appliance Model Tag (optional)
4th Appliance
4th appliance Model Tag (optional)
5th Appliance
5th appliance Model Tag (optional)
6th Appliance
6th appliance Model Tag (optional)
Additional appliance
Additional appliance Model Tag (optional)
2nd Additional appliance
2nd Additional appliance Model Tag (optional)
3rd Additional appliance
3nd Additional appliance Model Tag (optional)
4th Additional appliance
4th Additional appliance Model Tag (optional)
5th Additional appliance
5th Additional appliance Model Tag (optional)
6th Additional appliance
6th Additional appliance Model Tag (optional)

Lets review and approve your selections.
Name: {name}

Location of Appliances:

{address} {addressLine}

{city}, MI {zipCode}

Plan Selected: {selectA}

Price Tier Selected: {selectYour}

*Number of add ons selected: {additionalOptions}

*(Add ons are only avaliable with Kitchen and Whole home palns)

Billing Cycle Selected: {billingCycle}

Appliances being added to this plan:

{washer} {dryer} {1stAppliance} {testAppliance68} {testAppliance69} {testAppliance70} {testAppliance71} {testAppliance72}{testAppliance73} {testAppliance74} {testAppliance75}{testAppliance76} {testAppliance77} {testAppliance78}

Amount to be Paid monthly:

{totalAmount}

Auto-Renewal Notice:
You’ll be charged every month until you cancel your subscription in accordance with the terms and conditions.
Name: {name}

Location of Appliances:

{address} {addressLine}

{city}, MI {zipCode}

Plan Selected: {selectA}

Price Tier Selected: {selectYour}

*Number of add ons selected: {additionalOptions}

*(Add ons are only avaliable with Kitchen and Whole home palns)

Billing Cycle Selected: {billingCycle}

Appliances being added to this plan:

{washer} {dryer} {1stAppliance} {testAppliance68} {testAppliance69} {testAppliance70} {testAppliance71} {testAppliance72}{testAppliance73} {testAppliance74} {testAppliance75}{testAppliance76} {testAppliance77} {testAppliance78}

Amount to be paid yearly:

{totalAmount41}

Auto-Renewal Notice:
You’ll be charged every year until you cancel your subscription in accordance with the terms and conditions..
Discount Code
If a valid code is entered, the discount will populate automatically
Discounted amount to be billed monthly during the 1st year
Plan will renew at regular price after 1 year
Discounted amount to be billed during the 1st year
Plan will renew at regular price after 1 year
If everything looks correct please proceed below.
What is your prefered time for us to call you?
We may need to reach out to you for additional information or questons.
Customer Signature*
Subtotal amount to be charged

Payment Details

USDThis amount will be charged today

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

LANE'S APPLIANCE PROTECTION PLAN

Lets get some basic information.

Tell us which appliances you want to have listed on the plan.

Lets review and approve your selections.

If everything looks correct please proceed below.