Splashprotect - Merchant Application

Adding Profit To Every Sale!

Merchant Enrollment Please complete ALL Information
Merchant Name:
Contact:
Title:
Street: City/State: Zip:
Phone: Fax:
E-Mail Address:
Estimated Monthly Number of ESC:
Number of Locations:
States:
Effective Date: MM/DD/YYYY
Buying Group/Assoc's:
Self-Servicing DLR? Yes No
Programs Desired
Spas	Grills
36 mos.	24 mos.
60 mos.	36 mos.
72 mos.	60 mos.
Other
Comments:
Please enroll me in the Splash Protect Extended Service Contract Program.

Visit our affiliate 4warranty Corporation to learn about our other Extended Service Plan products and services.

2301 Park Avenue, Suite 402
Orange Park, FL 32073-5568
(904) 215-8804