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Enrollment Form for Newly Constructed Home
One simple form enrolls your newly constructed home into our Extended Warranty Program.
Key Estates Home Enrollment Form (Builders)
"
*
" indicates required fields
Builder Info:
Company Name
*
Date Construction Was Completed
MM slash DD slash YYYY
Date of Closing
MM slash DD slash YYYY
Purchaser Contact Info:
Name
*
First
Last
Phone
*
Email
*
Street Address
*
City
*
State
*
Select Your State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Is mailing address same as enrolled home?
*
Select an Option
Yes
No
Mailing Street Address
*
Mailing City
*
Mailing State
*
Select Your State (Mailing)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip
*
Coverage Option(s):
Plan Term
*
Select a Term
2 Years
3 Years
5 Years
Service Fee (2 years)
*
Select a Fee
$25 Service Fee (Plan Cost: $275)
$50 Service Fee (Plan Cost: $220)
$100 Service Fee (Plan Cost: $195)
Service Fee (3 years)
*
Select a Fee
$25 Service Fee (Plan Cost: $415)
$50 Service Fee (Plan Cost: $360)
$100 Service Fee (Plan Cost: $330)
Service Fee (5 years)
*
Select a Fee
$25 Service Fee (Plan Cost: $550)
$50 Service Fee (Plan Cost: $495)
$100 Service Fee (Plan Cost: $470)
Optional Coverage Requested (Select all that apply)
Guardian Package ($39)
Freezer ($33)
Ice Maker ($17)
Pool Only ($110)
Spa Only ($94)
Pool/Spa Combo ($138)
Roof Leak Repair ($83)
Septic ($39)
Well Pump ($44)
Washer/Dryer/Fridge ($110)
Optional Coverage Requested (Select all that apply)
Guardian Package ($44)
Freezer ($39)
Ice Maker ($22)
Pool Only ($121)
Spa Only ($105)
Pool/Spa Combo ($149)
Roof Leak Repair ($94)
Septic ($44)
Well Pump ($50)
Washer/Dryer/Fridge ($121)
Optional Coverage Requested (Select all that apply)
Guardian Package ($55)
Freezer ($50)
Ice Maker ($33)
Pool Only ($143)
Spa Only ($127)
Pool/Spa Combo ($171)
Roof Leak Repair ($116)
Septic ($55)
Well Pump ($61)
Washer/Dryer/Fridge ($143)
Guardian Package (2 years)
Price:
Guardian Package (3 years)
Price:
Guardian Package (5 years)
Price:
Ice Maker (2 years)
Price:
Ice Maker (3 years)
Price:
Ice Maker (5 years)
Price:
Freezer (2 years)
Price:
Freezer (3 years)
Price:
Freezer (5 years)
Price:
Spa Only (2 years)
Price:
Spa Only (3 years)
Price:
Spa Only (5 years)
Price:
Pool Only (2 years)
Price:
Pool Only (3 years)
Price:
Pool Only (5 years)
Price:
Pool/Spa Combo (2 years)
Price:
Pool/Spa Combo (3 years)
Price:
Pool/Spa Combo (5 years)
Price:
Roof Leak Repair (2 years)
Price:
Roof Leak Repair (3 years)
Price:
Roof Leak Repair (5 years)
Price:
Septic (2 years)
Price:
Septic (3 years)
Price:
Septic (5 years)
Price:
Well Pump (2 years)
Price:
Well Pump (3 years)
Price:
Well Pump (5 years)
Price:
Washer/Dryer/Refrigerator (2 years)
Price:
Washer/Dryer/Refrigerator (3 years)
Price:
Washer/Dryer/Refrigerator (5 years)
Price:
Total
Payment & Terms:
PLEASE NOTE: Repair coverage begins on the Warranty home's purchase date (“Effective Date”) and continues for the term selected by the Purchaser. The Service Fee selected is payable on a “per trade call” basis. Except for the optional coverage for washer, dryer or refrigerator supplied by the Purchaser (if this coverage is purchased by the Purchaser), coverage is provided only on systems and appliances installed or supplied by the original Builder. By signing this application, the Purchaser certifies that all covered appliances and systems are sound and in good working order at the time of purchase of this Agreement. Any dispute regarding this Agreement will be submitted to binding arbitration as provided in the Agreement. This program is separate from any structural or other coverage provided by the Builder. A confirmation receipt will be returned to you to confirm enrollment. Refer to Agreement for terms, conditions and limitations. THE MAXIMUM LIABILITY OF USHP UNDER THIS AGREEMENT SHALL NOT EXCEED AN AGGREGATE EQUAL TO $25,000.
Consent
*
I have read & understand this statement and I agree. I affirm that I am authorized to enroll this home for warranty coverage. By clicking this statement, I am electronically signing this enrollment form and submitting the home for coverage.
*
Payment Options:
*
Select an Option
Pay Now
Pay at Final Closing
Credit Card
*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
Security Code
Cardholder Name
Billing Street Address
*
Billing City
*
Billing State
*
Select Your State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
5 Digit Zip Code
*
Comments
This field is for validation purposes and should be left unchanged.
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home
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