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MAINTENANCE AND SERVICE AGREEMENT FORM
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 This form is intended for online review only. It may not print accurtely on some printers.
For your convenience, a PDF printable version of this form is available by clicking the icon to the right. If you are not familiar with PDF or do not have a FREE copy of Adobe Acrobat Reader®, click here
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ENROLL ME IN THE FOLLOWING PLAN(S): (Check below if you wish to order)
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BASIC HOUSE HEATER CONTRACT $139.00 (natural gas, electric and propane)
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$ __________
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PREMIUM HOUSE HEATER CONTRACT $198.00 (natural gas, electric and propane)
(Inludes Basic House Heater Repair Contract Plus a Pre-Season Check-Up)
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$ __________
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GAS HOUSE HEATER PRE-SEASON CHECK-UP PLAN $99.00 (natural gas, propane)
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$ __________
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WATER HEATER REPAIR CONTRACT $48.00 (natural gas, propane, electric)
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$ __________
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BASIC/CENTRAL AIR CONDITIONING/HEAT PUMP CONTRACT $139.00
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$ __________
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PREMIUM AIR CONDITIONING/HEAT PUMP REPAIR CONTRACT $198.00
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$ __________
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CENTRAL AIR CONDITIONING/HEAT PUMP PRE-SEASON CHECK-UP PLAN
$99.00
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$ __________
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TOTAL ENCLOSED OR CHARGED TO CREDIT CARD
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$ _________
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Covers one of each item mentioned. For example, if you have two central air units, you need to purchase two of the same option to have
both covered. 30-day waiting period applies before coverage takes effect for new enrollees. Prices include applicable sales tax. Equipment must be in good working order at time of
enrollment. Please do not staple or paperclip your check to this form. Please return entire form with your payment.
NOTE: These prices are offered for a limited time only.
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METHOD OF PAYMENT
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I have read and agree to the Terms and Conditions for the Masciantonio Heating and Air Conditioning Maintenance and Service Agreement Plan(s) I
am purchasing:
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Check Enclosed (make payable to: Masciantonio Heating & Air Conditioning)
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Bill my credit card:
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MasterCard
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VISA
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Card Number: Expires
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Signature: ____________________________________
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Date: ___________
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Daytime Phone: ________________________________
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Evening Phone: _______________
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Name: __________________________________________________________________________________________
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Address: __________________________
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City: ________________________
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State: ___
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Zip: _________
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.