Liberty Authorized Contractor Protection Plan Enrollment

This form is to be used by Liberty Authorized Contractors.

Please have photos of the appliance(s) ready.

Plans are subject to the Residential Protection Plan Terms and Conditions.

							Company*
						
							Your Name*
						
							Email Address*
						
							Telephone*
						
							Service Address*
						
							Please indicate which equipment plans the customer wishes to enroll in:
						
  Furnace Protection Plan
  Boiler Protection Plan
  Combination Boiler Protection Plan
  Air Conditioner Protection Plan

							Please indicate which water heating equipment plans the customer wishes to enroll in:
						
  Tank-Type Water Heater Protection Plan
  Indirect Water Heater Protection Plan
  Tankless Water Heater Protection Plan

							Equipment Installation Date (MM:DD:YYYY)
						
							Description
						
							Terms and Conditions for Contractors
						
  A copy of the Liberty Protection Plan Terms and Conditions were reviewed and left with the customer.