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• Zero deductible!
• 24/7/365 LIVE call answering
• FLEXIBILITY of choice for
Protect what matters qualified local service providers
2020–21
Home Warranty
of the Midwest, Inc.
PLAN
(877) 977-4949 toll-free • homewarrantyinc.com © 2020
Why buy Appliance
Protection Plan over
other service plans?
Why buy Appliance Unlike most extended warranty plans, your appliances are
covered regardless of age and the price never changes
Protection Plan? just because your appliance gets older.
Appliance Protection Plan provides you with peace The Appliance Protection Plan is one of the most complete
of mind. No more worrying about having unexpected, and comprehensive plans. Home Warranty has some of
expensive repairs for appliances. the most competitive rates in the business—less than
half of some major competitors.
There is no deductible or extra charge for a service call,
mileage, parts, or labor. There are no hidden fees or extra expenses when you
have an appliance repair.
In the event that an appliance is not repairable or the repair
is above the replacement value of the appliance, Home Home Warranty provides money towards the purchase
Warranty provides money toward the purchase of a new of a new appliance if yours is not repairable, allowing you
one. There is a replacement allowance equal to 100% of to upgrade to the make, model, and color of appliance
the money paid in on that appliance to a maximum of you desire—no need to settle for a low-end replacement
$400 for regular appliances (except refrigerators), $600 on appliance.
refrigerators and $1,000 for furnaces and air conditioners.
This means 100% of the coverage you pay on an item
goes toward the eventual replacement of that same item!*
Now there is no searching in the phone book to find a repair
company. One toll-free call to our 24 hour/365 days-a-year
Claim Center, and we match you with a reputable service
company in your area.
homewarrantyinc.com
• Furnace • Built-in or Over-
• Air-to-Air Heat the-Range
Pump Microwave
• Annual Furnace • Refrigerator
Inspection • Stand Alone
• Air Conditioner Freezer
• Water Heater • Dishwasher
• Trash Compactor • Range/Stove
• Cooktop Stove
• Wall Oven
• Washer
• Dryer
• Water Softener
Even your smallest purchases come with a warranty.
Shouldn’t your largest?Appliance Protection Plan “Items Available for Coverage” below, the item or part is not
covered.
7. Refrigerator/Stand Alone Freezer
COVERED: All components and parts except:
Agreement 12. There is no deductible for coverage under this NOT COVERED: Ice makers, ice crushers, beverage dispensers
Current terms and conditions of actual Agreement available at Agreement. and associated parts. Interior thermal shells or liners. Food
homewarrantyinc.com and included in client welcome packet spoilage. Drain heaters. Inaccessible leaks.
upon payment of plan fees. ITEMS AVAILABLE FOR COVERAGE
8. Dishwasher
1. Furnace or Air-to-Air Heat Pump
For service or questions, call toll-free COVERED: All components and parts including racks, baskets,
NOTE: Coverage on furnace or air-to-air heat pump repairs
(877) 977-4949 or visit homewarrantyinc.com is limited to $1,000 per contract year.
rollers, portable units in home at time of warranty inception.
NOT COVERED: Cleaning or repair due to failure caused by
COVERAGE REQUIREMENTS COVERED: Main heating and associated parts and components foreign objects, scale, rust, minerals, and other deposits. Rack
including blower fan motors, burners, controls, fan blades, replacement is at Our discretion.
1. All covered systems and appliances must be in normal heat/cool thermostats, damper or zone control systems, heat
operating condition at the time coverage takes effect. Conditions exchangers, heating elements, ignitor and pilot assemblies, 9. Range/Oven/Cooktop Stove/Wall Oven
determined to have existed prior to the coverage period or internal system controls, wiring and relays, motors and switches, COVERED: All components and parts except:
systems and appliances that never functioned properly during air handler, capacitors, compressors, condenser fan motors,
the period of warranty coverage are pre-existing conditions and NOT COVERED: Clocks (unless they affect the function of the
condenser coils, evaporator coils, fan blades, pumps, reversing oven). Meat probe assemblies or rotisseries. Racks. Magnetic
are not eligible for coverage under this Agreement. valves. induction. Glass. Thermostatic controllers will only be replaced
2. Agreement covers only repairs resulting from normal wear NOT COVERED: Portable or window units, solar heating with standard controls.
and tear associated with normal usage of covered items. systems, pellet or wood stoves, radiant cable heat, or fireplaces 10. Washer
3. Purchase or registration of the plan implies consent to all and associated components. Chimneys. Outside or underground
Agreement terms and conditions. COVERED: All components and parts except:
piping. Circulation components or re-drilling of wells for water
4. Coverage starts on the date of application, provided that source heat pumps. Fuel storage tanks. Expansion tanks. NOT COVERED: Fabric softener dispensers. Filter screens.
fees are received within 15 business days, and continues for Filters. Timers. Heat lamps. Humidifiers or dehumidifiers. Knobs and dials. Damage to clothing.
the number of years purchased. Condensate drain pump. Flues and vents. Improperly sized 11. Dryer
systems. Cleaning and maintenance. Free-standing or gas log COVERED: All components and parts except:
COVERAGE systems, including gas supply lines. Dampers. Pressure reg NOT COVERED: Venting. Knobs and dials. Damage to clothing.
1. Agreement provides for repair (including parts and labor) ulators. Computerized energy management systems. Electronic
12. Water Softener
or replacement on all items for which coverage has been air cleaners. Water towers. Roof jacks and stands. Any system
purchased (subject to terms and limitations of this Agreement). with asbestos. Heat recovery units. Interconnecting refrigerant COVERED: All parts and components except:
2. Items for which parts or technical information are not available lines. Water pumps. Water cooling towers. Improper use of NOT COVERED: Rental units are not eligible for coverage.
(other than non-readable or missing make, model or serial metering devices. Insulation. Concrete pads. Baseboard, cas Resin bed or resin replacement.
numbers) or items for which the repair exceeds replacement ings, registers and radiators tied to boiler systems. Boiler.
2. Air Conditioner
LIMITATIONS AND EXCLUSIONS
cost of the item will be deemed non-repairable. A customer
whose mechanical system or appliance has been deemed non- 1. Conditions resulting from Your negligence, acts of God, or
NOTE: Coverage on air conditioner repairs is limited to
repairable will be given the monies available in the Replacement situations beyond what We consider to be normal usage are not
$1,000 per contract year.
Account. Items for which parts or technical information are not covered (including but not limited to abuse, pet/pest damage,
COVERED: Cooling system (including a heat pump, central air theft, water, flood, fire, lightning, freezing, earth movement, wind,
available due to non-readable or missing make, model and conditioner, or water evaporative cooler unit) and associated
serial numbers will be assessed a repair estimate based on a improper installation/alteration, lack of adequate power or water
parts and components including blower fan motors, controls, supply, power failure/surges, blown fuses or tripped breakers,
comparable repair. fan blades, heat/cool thermostats, damper or zone control unplugged appliances).
3. The Replacement Account consists of 100% of the money systems, internal system controls, wiring and relays, motors and
paid in for this Agreement on a covered item, subject to a 2. Service will not be performed on systems with hazardous/
switches, air handler, capacitors, compressors, condenser fan
maximum of $400 for appliances (except refrigerators), toxic materials or asbestos, nor does Agreement provide for
motors, condenser coils, evaporator coils, fan blades, pumps,
$600 for refrigerators and $1,000 for furnaces, air-to-air heat any removal, disposal, or demanufacturing of an appliance or
refrigerant filter dryer, refrigerant piping, reversing valves.
pumps, or air conditioners. Replacement Account monies mechanical system or any costs associated with the removal,
NOT COVERED: Portable or window units. Outside or under reclamation, or disposal of materials, chemicals, or fluids
shall be kept in the account until the covered item is deemed non- ground piping. Circulation components or re-drilling of wells for
repairable. Replacement Account ceases to exist upon expiration associated with repair or replacement of a mechanical system
water source heat pumps. Fuel storage tanks. Expansion tanks. or appliance.
of the Agreement. Filters. Timers. Humidifiers or dehumidifiers. Condensate drain
4. We may (at Our discretion) allow You to forgo repair and 3. Any system or appliance outside the confines of the home
pump. Flues and vents. Improperly sized systems. Cleaning
apply an amount up to what the repair would have cost to the is not covered with the exception of central air conditioning or
and maintenance. Pressure regulators. Computerized energy
replacement of an item instead, but allowance will never exceed heat pump units.
management systems. Gas air conditioning systems. Electronic
Our estimate of remaining cost of repair, regardless of age or air cleaners. Water towers. Roof jacks and stands. Chillers. Any 4. Appliances or mechanical systems used for commercial
condition of the item. system with asbestos. Interconnecting refrigerant lines. Water or home business use (included but not limited to day care,
5. We have sole discretion to choose service personnel pumps. Water cooling towers. Improper use of metering devices. beauty salon, catering) are not eligible for coverage.
and will not reimburse for work performed without its prior Pre-coolers. Insulation. Concrete pads. Costs related to adding 5. Agreement does not cover any repairs already covered by
approval or by service personnel contacted directly by the or recapturing refrigerant. a manufacturer’s warranty, recall notice or service bulletin, or
customer unless directed to do so by Us except in the case 3. Annual Furnace Inspection manufacturer’s defect.
of emergency repairs described below. Customers who sign up for annual inspections on an item must 6. Cosmetic and non-operational repairs are not covered
6. All requests for service not answered immediately will be also be signed up for coverage on that item. It is the responsibility (including but not limited to noise, odor, corrosion, clocks/
acknowledged with a return phone call within 4 hours during of customers who are signed up for annual inspections to contact timers, self-cleaning function or other parts not affecting the
normal working hours and 48 hours on weekends and holidays. Us annually to request the inspection. Inspections are limited to core operation of the item, loss of some optional functions,
Agreement allows for You to contact Us and schedule service one per contract year and no refund will be given on inspections computerized monitoring equipment). Agreement does not pay
during normal business hours. You may elect to have after that the customer failed to schedule within a contract year. for repairs associated with lack of performance due to improperly
hours service performed at Your own discretion but You will be sized systems, failure to conduct routine maintenance, or build-
4. Water Heater
responsible for any additional fees associated with expediting the up of lime, scale, sediment or other chemical deposits, color or
service. We reserve the right to obtain a second opinion. In the COVERED: Main unit (Including a tank, tankless, or power vent purity of water.
event of an after hours emergency, to obtain service please call unit), exhaust blower assembly, water heater elements, gas
7. Agreement does not pay for services associated with routine
toll-free 24/7/365 at (877) 977-4949 and remain on the line. control valves, and thermostats. Coverage on water heater
maintenance (including but not limited to cleaning, lubricating,
is limited to $500 per contract year.
7. We reserve the sole right to determine whether a covered filter replacement, or when no failed parts are detected or failure
system or appliance will be repaired or replaced and to limit the NOT COVERED: Solar water heaters and components. is unable to be duplicated).
amount paid on any individual repair or replacement. Thermal expansion or holding tanks. Noises. Odors. Color or
8. This Agreement is not an insurance policy and will not
purity of water. Flues and vents. Insulation blanket. Hot water
8. If a property has multiple mechanical systems or appliances duplicate or substitute for coverage provided under any insurance
dispensers are considered secondary water heaters and are not
that require the purchase of additional coverage in order to be policy.
covered unless optional coverage is purchased. Combination
covered and additional coverage is not purchased, We will limit water heaters/boilers and components unless purchased as a 9. Any removal, repair, or replacement of systems whose defect
coverage to the appliance specified in the application. secondary heating unit. is caused by moisture (including but not limited to mildew, mold,
9. We reserve the right to have the repair or replacement rot, fungus, corrosion) is not covered.
5. Trash Compactor
performed with after-market, off-brand, used, remanufactured, 10. Consumable or expendable items are not covered (including
or reconditioned parts. COVERED: All components and parts except:
but not limited to filters, light bulbs).
10. Notice of any malfunction must be given to Us prior to NOT COVERED: Lock and key assemblies. Removable buckets.
11. We will not be responsible for any work or expense
Agreement expiration with the initial service call scheduled 6. Built In or Over the Range Microwave (including permits) needed to bring systems into compliance
within 30 days and all approved work must be completed within COVERED: All components and parts except: with federal, state, local, utility, or any other jurisdiction’s codes
6 months of Agreement expiration. NOT COVERED: Portable, countertop, convection, infrared, or or regulations.
11. Unless a part of item is specifically listed under the high-speed units. Interior linings. Glass. Shelves. Meat probe 12. Food spoilage, clothing damage, damage to persons, real
“COVERED” section for the particular item in the section entitled assemblies or rotisseries. property, personal property, or any other items (whether coveredby this Agreement or not) due to the failure of, or lack of timely The Welcome Letter sent to You upon enrollment is incorporated obtaining this Agreement or in making a claim; or (4) discovery
repair or replacement of, an appliance or system is not covered. into these terms and conditions. of either of the following if it occurred after the effective date
13. Removal or reconstruction of, or subsequent or incidental Agreement is subject to state and local sales taxes where of the Agreement and substantially and materially increased the
damage to, systems, appliances, units, or walls, floors, carpeting, applicable. We reserve the right to change/amend plan prices, service required under the Agreement: (a) an act or omission
tile, ceilings and the like necessary to make repairs is not covered. coverage, or Agreement terms without notice. Customer agrees by the holder; or (b) a violation by the holder of any condition of
14. Any system or appliance where You have failed or refused to to settle all disputes associated with this Agreement exclusively the Agreement.
provide a service company access to the item or its supporting through final and binding arbitration, unless the laws of the state North Carolina residents: We may only cancel this
systems is exempt from coverage. where the Covered Property is located requires otherwise, on an Agreement for Your nonpayment or for a direct violation of this
15. This Agreement does not cover delays or failures to provide individual basis only, and not in any form of class, collective, or Agreement by You.
service caused by or related to any of the exclusions listed private attorney general representative proceeding (“Class Action Oklahoma residents: In Oklahoma, We are operating under
therein, shortages of labor or materials, or unwillingness of a Waiver”). This binding arbitration provision does not prevent the First Home Warranty of the Midwest (Oklahoma ID #503353503).
filing of a complaint with a governmental administrative agency
servicer to perform service due to verbal abuse, threat of legal South Carolina residents: In the event of a dispute with the
action or requests of the servicer to violate ethical standards or to the extent such complaints are permitted notwithstanding an
provider of this Agreement, You may contact the South Carolina
misrepresent the true nature of the diagnosis. agreement to arbitrate. This Agreement shall be construed, and
Department of Insurance, Capitol Center, 1201 Main St., Ste.
the legal relations between the parties determined, in accordance
16. Any system or appliance that is operating within regulatory 1000, Columbia, SC 29201 or (800) 768-3467.
with the laws of the State of Iowa. Purchase of this warranty may
(including by not limited to EPA, OSHA, state or local building result in Us paying a fee or commission to the agent or sales TEXAS RESIDENTS: Service under this Agreement will
codes) or industry trade (including but not limited to ASHRAE, associate who obtained the sale. Obligations of the provider be initiated within 48 hours of a requires for service being
BPI) standards for carbon monoxide emissions or refrigerant under this Agreement are backed by the full faith and credit of made. We may not cancel this Agreement for any reason
loss is considered safe for operation and is not eligible for the provider and are not guaranteed under a reimbursement other than nonpayment of the purchase price by You,
repair or replacement under this Agreement until levels exceed insurance policy. fraud, or misrepresentation by You, or if the Agreement is
these standards.
STATE-SPECIFIC AMENDMENTS contingent on an interest in real property not being sold.
TRANSFER, CANCELLATION Alabama and Indiana residents: Our obligations under this This Agreement is issued by a Residential Service Company
AND RENEWAL Agreement are backed by reimburse ment insurance policy licensed by the Texas Real Estate Commission. Complaints about
issued by Chubb Group of Insurance Companies, 202B Hall’s this Agreement or company may be directed to the Texas Real
1. Transfer: This Agreement is transferable to a new owner of
Mill Road, Whitehouse Station, NJ 08889, (800) 699-9916. If We Estate Commission at P.O. Box 12188, Austin, TX 78711-2188,
the home, but remains tied to the originally warrantied systems
have not paid a claim or provided service within 60 days of Your (512) 936-3049. The purchase of a residential service contract or
and appliances.
request being made, including refunds, You are entitled to make home warranty contract is optional and similar coverage may be
2. Cancellation by Us: We reserve the right to change or a claim directly with the insurer. purchased from other residential service companies or insurance
cancel this Agreement upon 30 days written notice stating companies authorized to conduct business in Texas.
Colorado residents: This Agreement may be covered by the
the reason for an effective date of cancellation mailed to
Colorado Consumer Protection Act and/or the Unfair Practices NOTICE: YOU THE BUYER HAVE OTHER RIGHTS AND
Your last known address in Our records. In the event of fraud,
Act, Article 1 of Title 6 of the Col. Rev. Stat. You may have a right REMEDIES UNDER THE TEXAS DECEPTIVE TRADE PRAC-
material misrepresentation (including misrepresentation of
to civil action under those laws, including obtaining the recourse TICES–CONSUMER PROTECTION ACT WHICH ARE IN
equipment condition), or failure to pay, cancellation may
or penalties specified in those laws. Repairs will begin within 48 ADDITION TO ANY REMEDY WHICH MAY BE AVAILABLE
be immediate and without notice unless otherwise stated
hours after We return Your call or as otherwise agreed. UNDER THIS AGREEMENT. FOR MORE INFORMATION
below in “STATE-SPECIFIC AMENDMENTS.” If We cancel
this Agreement, We shall refund to You 100% of the unearned Georgia residents: No claims paid will be deducted from any CONCERNING YOUR RIGHTS, CONTACT THE CONSUMER
prorated purchase price based on months remaining on the refund owed. We may not cancel this Agreement for any reason PROTECTION DIVISION OF THE ATTORNEY GENERAL’S
Agreement, except for cancellation for nonpayment by You, other than nonpayment of the purchase price by You, fraud, or OFFICE, YOUR LOCAL DISTRICT OR COUNTY ATTORNEY
in which case no refund will be provided. No cancellation misrepresentation by You. This Agreement is backed by a surety OR THE ATTORNEY OF YOUR CHOICE.
fee shall be assessed if this Agreement is cancelled by issued by Travelers Casualty and Surety Company of America,
Signature: ___________________________________
Us unless otherwise stated below in “STATE-SPECIFIC 1 Tower Square, 2MS, Hartford, CT 06183. You have the right to
AMENDMENTS.” make a direct claim to Travelers Casualty and Surety Company Agreement Number: ____________________________
3. Cancellation by You: You may cancel this Agreement at of America in the event that We do not pay a claim or provide a (We will provide)
any time for any reason by submitting a written cancellation refund within 60 days after You have filed the proof of loss.
request to: Home Warranty of the Midwest, P.O. Box 1, Rock Illinois residents: A cancellation fee of the lesser of $50 or NOTICE: THIS COMPANY PAYS PERSONS NOT
Rapids, IA 51246. Cancellation becomes effective at the end 10% of the purchase price of the Agreement will be assessed EMPLOYED BY THE COMPANY FOR THE SALE,
of the current month of coverage: on any cancellation. ADVERTISING, INSPECTION, OR PROCESS-
a. If You cancel this Agreement within the first 30 days Iowa residents: The issuer of this Agreement is subject ING OF A RESIDENTIAL SERVICE CONTRACT
from the date of purchase and no claims have been to regulation by the Insurance Division of the Department UNDER TEXAS OCCUPATIONS CODE §1303.304.
made, You are entitled to a refund of the full purchase of Commerce of the State of Iowa, Commissioner: Doug
price of the Agreement and no cancellation fee will be Ommen, 1963 Bell Avenue, Suite 100, Des Moines, IA 50315. Utah residents: Coverage afforded under this contract is not
assessed unless otherwise stated below in “STATE- Complaints that are not settled by the issuer may be sent to the guaranteed by the Property and Casualty Guaranty Association.
SPECIFIC AMENDMENTS.” If You are entitled to a refund Insurance Division, 1963 Bell Avenue, Suite 100, Des Moines, Obligations of the provider under this service contract are
for such cancellation and such refund is not paid within IA 50315. The time period for payment of a full refund before guaranteed under a service contract reimbursement insurance
45 days, a penalty of 10% of the purchase price shall a penalty is assessed is amended from 45 days to 30 days. policy. Should the provider fail to pay or to provide service on a
be added to Your refund for each month such refund Kentucky residents: The maker maintains a performance claim within 60 days after proof of loss has been filed, the service
remains unpaid. bond in accordance with the regulations as set forth by the contract holder is entitled to make a claim directly against the
b. If You cancel this Agreement after 30 days from the Commonwealth of Kentucky. The holder of the Agreement reimbursement insurance company. In the event of a dispute
date of purchase or after a claim has been made, You are shall be entitled to make a direct claim against the insurer upon with the provider of this Agreement, you may contact the Utah
entitled to a prorated refund of the unearned purchase the failure of the maker to pay any claim within 60 days after Department of Insurance at 350 N. State St. State Office Building
price based on months remaining on the Agreement, the claim has been filed with the maker: United States Fire Rm. 3110, Salt Lake City, UT 84114 or (800) 439-3805.
less the cost of claims paid and a cancellation fee Insurance Company, 11490 Westheimer Rd, Ste. 300, Houston, Wisconsin residents: THIS AGREEMENT IS SUBJECT
of the lesser of $50 or 10% of the purchase price, TX 77252-2807. TO LIMITED REGULATION BY THE OFFICE OF THE
unless otherwise stated below in ”STATE-SPECIFIC Michigan residents: If performance of the Agreement is COMMISSIONER OF INSURANCE. A cancellation fee of the
AMENDMENTS.” interrupted because of a strike or work stoppage at the company’s lesser of $50 or 10% of the purchase price of the Agreement
3. Renewal: Agreements are renewable at Our discretion and place of business, the effective period of the Agreement shall be will be assessed on cancellations by Us.
where permitted by law. We will notify You of renewal rate and extended for the period of the strike or work stoppage.
Agreement terms if applicable. Plan renewals take effect from Minnesota residents: In the event of Our cancellation of this
the anniversary of the original closing date and are for a period Agreement due to Your nonpayment of the purchase price or
of 1 year. material misrepresentation, We will provide only 5 days’ notice
4. Any renewals effectuated after the anniversary date has of cancellation.
expired will be subjected to a 30-day waiting period before New Mexico residents: The time period for payment of a full
coverage will resume. refund before a penalty is assessed is amended from 45 days
MISCELLANEOUS to 60 days. We may not cancel this Agreement once it has
been in effect for 70 days except for (1) Your failure to pay an
This Appliance Protection Plan (“Agreement”) is between the amount when due; (2) Your conviction for a crime that results
provider, Home Warranty of the Midwest, Inc., P.O. Box 1, Rock in an increase in the service required under the Agreement;
Rapids, IA, 51246, (877) 977-4949 (“We”, ”Us”, and “Our”) and (3) discovery of fraud or material misrepresentation by You in
the purchaser (“You” and “Your”).
Form APP Rev 12/01/2020Homeowner Information
Name:
Address:
Appliance Protection City/State/ZipCode:
Plan Registration Home Phone: ( )
Email Address:
Alt. Phone: ( )
For questions, Referring Company:
call toll-free (877) 977-4949
Rep. Name:
Select Coverage Rep. Email Address:
PRICES (add sales tax if applicable) Air-to-Air Heat Pumps are $14 each/month. Prices valid until
Annual Inspections and Home Appliances are $5 each/month. 12/31/2021. After that, call or verify prices online at
Furnaces and Air Conditioners are $7 each/month. homewarrantyinc.com.
APPLIANCE/UNIT BRAND MONTHLY PRICE
STAPLE VOIDED CHECK HERE
1. $
2. $
3. $
4. $
5. $
6. $
7. $
8. $
9. $
10. $
Sales Tax (AR / NC / NM / SD / WV Only) $
Agreement
Purchase or registration of this plan implies consent to all Agreement terms and
TOTAL $
conditions. Were the heating and cooling systems in this property inspected by a professional
This plan does not cover any pre-existing conditions and requires all appliances and contractor? __ Yes __ No
mechanical systems to be in normal working condition when this plan takes effect. Please attach completed inspection or invoice not over 30 days old from professional
We do not require, but strongly encourage, inspections of covered items (especially heating and cooling contractor.
heating and cooling systems) by professional contractors in order to help reduce or
eliminate the risk that an item will be precluded from coverage due to a pre-existing Confirmation Number:
condition. (We will provide)
Billing Information __ ACH debit from checking/savings __ Credit card (provide card info below)
account (be sure to attach a voided check) Check one: q MasterCard q Visa q Discover
Sign up for monthly checking, savings or credit card
payment and coverage prior to the first payment is
FREE! Bank name Name on card
__ ANNUALLY: Enclose check for the annual amount.
Mail to Home Warranty of the Midwest, Inc. 9-digit financial institution routing # 16-digit credit card number
P.O. Box 1, Rock Rapids, IA 51246
Financial institution checking/savings account # Expiration date (mm/yy) 3-digit security code
__ M
ONTHLY (select an option at right): Automatic
ally debit my checking, savings or credit card monthly
Signature for monthly account debit Billing address (if different than mailing address)
(attach a voided check or deposit slip). Payments are
withdrawn on the 5th or 20th day of the month. Note:
will remain in effect until Agreement is canceled. Date Cardholder signature
Ordering Instructions
Contact Us with completed registration information using one of these methods:
Online: homewarrantyinc.com
Protect what matters Email: info@homewarrantyinc.com
Phone: (877)977-4949 • Fax: (866)977-4949
Mail: Home Warranty of the Midwest, Inc.
P.O. Box 1 • 303 S. Second Ave. • Rock Rapids, IA 51246
Form APP Rev 12/01/2020You can also read
