RE warranty packages – Alpine Home Warranty

Buyer Name and Phone Number*

Buyer Email*

Seller Name and Phone Number

Seller Email

Full Address of Warranted Property

Street Address City ZIP Code

Real Estate Agent's Name*

Real Estate Agent's Phone Number*

Real Estate Agent's Email*

Title Company/Escrow Officer's Name

Title Company/Escrow Officer's Phone Number

Title Company/Escrow Officer's Email

Warranty Package Options (Please Select ONE)*

Basic • 1 Year Coverage $400
Platinum • 1 Year Coverage $500
Alpine • 1 Year Coverage $625
New Construction • 2 to 5 Year Coverage $650

Optional Coverage Options (Select All That Apply)

Washer and Dryer (1 set) • $100
Central Vacuum System • $25
Refrigerator (1 unit) • $50
Double Oven • $50
Roof Coverage • $100
Pre-Paid Deductible • $50
Re-Key (No deductible due) • $100

Payment Options

Salesperson

Instructions, Information, & Property Condition

Property Condition Declaration*

Special instructions, information, or please note any defective items

• Alpine Home Warranty does not reimburse. You must call prior to service. There is a $60 service call deductible. • By submitting, I hereby declare that to the best of my knowledge and belief, all systems of the property to be covered by AHW are currently in good working order or are listed above. I understand that excluded items will be reinstated when AHW receives proof of repair or replacement. *Please call our office outside of regular business hours to be connected with our 24 hour emergency service.