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Acceptance FormPlease confirm your name and address below and make any changes if necessary.
<br />E-mail Address Phone #
<br />By providing my e-mail address, I request that I be notified when my current and future service agreements and any related documents are available at
<br />www.slwofa.com, and I acknowledge that I can access these documents. I can change my preferences or request paper copies online or by calling SLWA.SLWA_XX_BLUPK_CChoose Your Protection Plan(s)
<br />BEST VALUE
<br />FIRST-YEAR SAVINGS OF XX% OFF
<br />when you select both plans
<br />MONTHLY YEARLY
<br />For fastest processing, please visit www.slwofa.com.
<br />To protect your privacy, we do not share your information except to deliver this service.
<br />Yes, please sign me up for the protection plan(s) from SLWA I have selected above. By signing below, I agree to the
<br />terms on the reverse side, understand there are limitations and exclusions, and meet the eligibility requirements for
<br />this coverage. SLWA will invoice me based on my selection above and I will select a payment method in the invoice. I
<br />understand this optional coverage is based on an annual contract and will automatically renew annually on the same
<br />payments terms I selected at the then current renewal price. I can always cancel at any time.
<br />Signature (required)
<br />Important Questions & Answers
<br />Visit www.slwofa.com to protect your exterior lines
<br />Or call toll-free 1-8XX-XXX-XXXX | Available: <<hours>>
<br />What am I responsible for?Nisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae.Does my homeowners insurance cover this?Nisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae laturestis re dellaccus voles eosItam etur quam nonsequo volecus ea que omnis estius raest rem quidus, quia aut ea suntist. Henis eatios aliquatur. Agnis voloria nienihil invende.Who is eligible for coverage?Nisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae laturestis re dellaccus voles eosItam etur quam nonsequo volecus ea que omnis estius raest rem quidus, quia aut ea suntist. Henis eatios aliquatur. Agnis voloria nienihil invendere dellaccus voles eosItam etur quam nonsequo volecus ea que omnis estius raest rem quidus, quia aut ea suntist. Henis eatios aliquatur. Agnis voloria nienihil invende nitates doluptam, que mi, voluptat et aspiducilic temod ut que et ant. Cerspientus solleniam, omnihit as dolo maximi, a ipsamet res sunt odi conse cori as Explignate cuptatem hilla eum con re quam faccumq.What should I know about this coverage?What’s covered: Nisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae laturestisisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae laturestis re dellaccus voles eosItam etur quam. Not covered: Nisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae laturestisisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae laturestis re dellaccus voles eosItam etur quam nonsequo.
<br />When can I make a service call?Nisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae laturestis re dellaccus voles eosItam etur quam nonsequo volecus ea que omnis estius raest rem quidus, quia aut ea suntist. Henis eatios aliquatur.What is the cancellation policy?Nisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae laturestis re dellaccus voles eosItam etur quam nonsequo volecus ea que omnis estius raest rem quidus, quia aut ea suntist. Henis eatios aliquatur. Agnis voloria nienihil invende.What is the term of my service agreement?Nisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae laturestis re dellaccus voles eosItam etur quam nonsequo volecus ea que omnis estius raest rem quidus, quia aut ea suntist. Henis eatios aliquatur. Agnis voloria nienihil invende.What is E-Z Pay?Nisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae laturestis re dellaccus voles eosItam etur quam nonsequo volecus ea que omnis estius raest rem quidus, quia aut ea suntist. Henis eatios aliquatur.What quality of repair can I expect?Nisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae.Who is SLWA?Nisit officii sintotatius et aturest emolore, ipitas dem et is exero con pa net, aspel exceptae laturestis re dellaccus voles eosItam etur quam nonsequo volecus ea que omnis estius raest rem quidus, quia aut ea suntist. dellaccus voles eosItam.SLWA_XX_BLUPK_CTake A Look At The Benefits You'll Receive <<Product Name>> <<Product Name>>
<br />1. Covered Repairs – Guaranteed for one full year.
<br />2. 24-Hour Emergency Repair Service Hotline – Open 24 hours a day, 365 days a year.
<br />3. Our Promise to You – If you are ever dissatisfied with your coverage, simply call
<br />SLWA toll-free 1-XXX-XXX-XXXX, and it will be discontinued at your request.
<br />What would you do in an exterior line emergency?
<br />‡ National average repair costs as of January 2016.
<br />No charge for covered repairs up to the benefit amount.
<br />The illustration shows where things may go wrong with your exterior lines and how much a licensed and insured plumber would typically charge customers who don't have coverage. How would you cope if it happened to you? With coverage, it's not something to worry about; you'll have no bill to pay for covered repairs up to the benefit amount.Replace water service line $2,587Plan Members: No Charge‡
<br />Replace sewer/
<br />septic line
<br />$3,929
<br />Plan Members:
<br />No Charge‡
<br /><<The water and sewer/septic lines beyond the <<property boundary>> may be an
<br />additional responsibility of the homeowner and are included in this coverage.>>
<br /><<Septic tanks, leaching fields, pumps or grinders>> are not covered.>>
<br />Property Boundary
<br />Water Meter/
<br />Main Shut-Off ValveWater Service Line
<br />Sewer/Septic Line Typical Homeowner’s Responsibility
<br />FPO
<br />Mailcode<<Sample A. Sample_xxxxx>><<Serv_Address1_xxxxxxx>><<Serv_Address2_xxxxxxx>><<Serv_City_xx, ST Zip>>
<br />$XX.XX $XX.XX $XXX.XX $XXX.XX
<br />$X.XX $XX.XX
<br />$X.XX $XXX.XX
<br /><<Mailcode-xxxx>>
<br /><<Mailcode-xxxx>>
<br /><<Mailcode-xxxx>>
<br /><<Product Name>> and <<Product Name>>
<br /><<Product Name>>
<br /><<Product Name>>
<br /><<Mailcode-xxxx>>11" long8.5" wide 8.5" wide0.5” GUTTER
<br />fold
<br />fold
<br />3.75"
<br />3.75"
<br />3.5"
<br />0.5” GUTTER
<br />F17_USP_CONTROL_CHOICE_BLPK_TEMPLATE.indd 2 12/1/17 12:21 PM
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