Insurance & Risk
Extended Warranty Agreement
Extended warranty/service plan agreement for products. Two signers (provider and customer).
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# Extended Warranty / Service Plan Agreement **Effective Date:** ___________ **Plan Number:** ___________ This Extended Warranty / Service Plan Agreement ("Agreement") is entered into by and between: **Provider:** ___________ ("Provider") **Provider Address:** ___________ **Customer:** ___________ ("Customer") **Customer Address:** ___________ **Customer Email:** ___________ **Customer Phone:** ___________ ## 1. Covered Product **Product Description:** ___________ **Brand/Manufacturer:** ___________ **Model Number:** ___________ **Serial Number:** ___________ **Original Purchase Date:** ___________ **Original Purchase Price:** $___________ **Product Category:** ___________ ## 2. Manufacturer's Warranty **Manufacturer Warranty Period:** ___________
Fields (41)
effective date
date · required
plan number
text · required
provider name
text · required
provider address
textarea · required
customer name
text · required
customer address
textarea · required
customer email
text · required
customer phone
text · required
product description
text · required
product brand
text · required
model number
text · required
serial number
text · required
purchase date
date · required
purchase price
text · required
product category
select · required
mfg warranty
select · required
mfg warranty expiration
date · required
plan type
select · required
coverage start
select · required
coverage period
select · required
coverage end
date · required
accidental coverage
select · required
battery coverage
select · required
plan price
text · required
plan payment
select · required
monthly payment
text
claim method
select · required
service delivery
select · required
response time
select · required
service schedule
select · required
claim limit
select · required
benefit cap
text · required
replacement threshold
select · required
no replacement
select · required
deductible
select · required
transferable
select · required
cancellation fee
text · required
governing state
select · required
provider signer name
text · required
provider signer title
text · required
customer signer name
text · required
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