Purchase a Service Contract
In order to give you the best price possible, we need to gather some personal information. Please rest assured that ECM does not, and will never, rent or sell customer information to outside marketers of any other company.

Please fill out the information required and we will contact you with your price within 72 hours. (* indicates required field)



HOME INFORMATION

Covered Residence
Address 1*
Address 2
City*
State*
Zip*
 

PERSONAL INFORMATION
Title
First Name*
Last Name*

Mailing Address
Same as home to be covered
Address 1
Address 2
City
State
Zip
 
Home Phone*
Other Phone
Email*
Name of development
Year home was built*
Type of home*


A/C SYSTEM INFORMATION

COVERED REPLACEMENT AIR CONDITIONERS
Central Air Conditioner #1 (Up to 5 tons)
Age*: Heat Recovery Unit
Central Air Conditioner #2 (Up to 5 tons)
Age: Heat Recovery Unit


APPLIANCE INFORMATION

COVERED REPLACEMENT ITEM
Refrigerator #1 (in kitchen)
Age*: Brand*: Model #:
Ice Maker Ice/Water Dispenser
Refrigerator #2
Age: Brand: Model #:
Ice Maker Ice/Water Dispenser
Freezer (stand alone)
Age: Brand: Model #:
Dishwasher
Age*: Brand*: Model #:
Oven/Range
Age*: Brand*: Model #:
Glass Cooktop Double Oven
Convection Oven Built-in Oven
Counter-top Range Range Hood
Electric* Gas*
Water Heater #1
Age*: Model #:
Electric Gas
Water Heater #2
Age: Model #:
Electric Gas
Clothes Washer
Age*: Brand*: Model #:
Stackable
Dryer
Age*: Brand*: Model #:
Electric Gas
Stackable
Microwave Oven (built-in)
Age*: Brand*: Model #:
Convection Microwave
Garbage Disposal (Up to 1/2 HP)
Age*: Model #:


PLUMBING AND ELECTRIC

COVERED QUANTITY ITEM
* Baths (toilets)
Exhaust Fans GFI Outlets
  Extended Plumbing


OPTIONAL COVERAGE

Many of our existing customers have requested additions to their contracts. The following features are options. Please let us know which of these you would like by checking the appropriate box
Air Conditioning Tune-Up
Obsolete Appliance Parts Coverage
Priority Air Conditioner Service
Priority Appliance Service

ADDITIONAL COMMENTS/INFORMATION

It is impossible to cover all possible items and options. Some people have more than 2 air conditioners or items not listed here. Please tell us if there is anything else in your home you would like covered under your policy or any other concerns or questions you may have. One of our courteous representatives will call you to discuss these issues. Thank you.