Quick Order Form

coolCARE Quick Order Form
Company Name
Account #
Skip if uncertain
Dealer Confirmation Email
example@example.com
Dealer Confirmation Email 2
example@example.com
Order with a Warranty Certificate?
Manufacturer Warranty Certificate

Equipment must have been installed less than 2 years from order date
Cancelof
Coverage Detail
Dealer PO:
Purchase Order
Agreement Charge $
What the customer paid for the warranty.
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Coverage Section
Install Type:
Equipment Type:
Example AC Full System / Heat Pump Full System
Thermostat - Does your warranty certificate include the thermostat details? This coverage includes a thermostat if replaced at the same time of the installation. If so, enter the model and serial numbers of the t-stat below

Model #Serial #
Coverage Type
Labor Coverage Length: (years)
Labor Rate
Parts Length: (years)
Notes:
List Specifics about your provided warranty documents or questions about coverage.
Brand
Are there multiple systems on the attached documents?
Do you have any added accessories you need coverage for?
Additional Accessory Options
THANK YOU Your Order is on the way! ONCE PLACED YOU'LL RECIEVE AN EMAIL WITH UPDATED STATUS AND ORDER NUMBER.

Do NOT complete this bottom section out.
Order Status
Needed information to complete order:
Missing Equipment Model & Serial

Other
Rep Email for Needed Information to Complete
example@example.com
Order #
Should be Empty:

coolCARE Quick Order Form