Basic Tier Signup Form

HomeGuard Pro -

Selected Plan: Basic Tier

Personal Information

Full Name: _______________________________

Phone Number: ____________________________

Email Address: ____________________________

Mailing Address (if different from home): _______________________________

Property Information

Home Address: _______________________________

City/State/ZIP: _______________________________

Are you the:

[ ] Owner / [ ] Occupant (non-owner / renter)

How long have you lived at this property? _______________________________(Optional)

Approximate age of the home (year built): _______________________________(Optional

Approximate square footage of the home: _______________________________ (Optional)

Known Current Problems or Concerns

Please list any existing issues with the home________________________________________________________________________________________________________________________________________________________________________________________

I certify that the information provided is accurate to the best of my knowledge. I understand that selecting the Basic Tier includes the standard terms and limitations of HomeGuard Pro services.

Signature: _______________________________   Date: ________________