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 路 required
plan number
text 路 required
provider name
text 路 required
provider address
textarea 路 required
customer name
text 路 required
customer address
textarea 路 required
customer email
text 路 required
customer phone
text 路 required
product description
text 路 required
product brand
text 路 required
model number
text 路 required
serial number
text 路 required
purchase date
date 路 required
purchase price
text 路 required
product category
select 路 required
mfg warranty
select 路 required
mfg warranty expiration
date 路 required
plan type
select 路 required
coverage start
select 路 required
coverage period
select 路 required
coverage end
date 路 required
accidental coverage
select 路 required
battery coverage
select 路 required
plan price
text 路 required
plan payment
select 路 required
monthly payment
text
claim method
select 路 required
service delivery
select 路 required
response time
select 路 required
service schedule
select 路 required
claim limit
select 路 required
benefit cap
text 路 required
replacement threshold
select 路 required
no replacement
select 路 required
deductible
select 路 required
transferable
select 路 required
cancellation fee
text 路 required
governing state
select 路 required
provider signer name
text 路 required
provider signer title
text 路 required
customer signer name
text 路 required
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