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Vehicle Service Contract
CONTRACT NUMBER:
APPLICATION PAGE
PURCHASER INFORMATION
PURCHASER NAME PHONE EMAIL ADDRESS
MAILING ADDRESS
CITY
STATE
ZIP CODE
SELLER INFORMATION
SELLER NAME PHONE EMAIL ADDRESS
MAILING ADDRESS CITY STATE ZIP CODE
VEHICLE INFORMATION
VIN # (MUST BE 17 DIGITS) YEAR MAKE MODEL
CURRENT ODOMETER READING
VEHICLE CLASS VEHICLE PURCHASE PRICE FINANCE COMPANY
DIESEL 4X4/AWD TURBO/SUPERCHARGER
SERVICE CONTRACT INFORMATION
SALE DATE COVERAGE CONTRACT TERM
(WHICHEVER COMES FIRST)
CONTRACT EXPIRATION
(WHICHEVER COMES FIRST)
MONTHS ODOMETER MILES MONTHS ODOMETER MILES
WAITING PERIOD
NEW
USED
DEDUCTIBLE
PURCHASE PRICE
OPTIONS
Administrator/Obligor: Endurance Dealer Services, LLC, 400 Skokie Blvd, Suite 105,
Northbrook, IL 60062 - (877) 414-0134. This is a Contract between You and the
Administrator/Obligor. The Administrator/Obligor’s performance under this Contract
is insured by Wesco Insurance Company, an Amtrust Group Insurance Carrier.
TIRE MODIFICATION/BODY OF SUSPENSION LIFT
COMMERCIAL
HIGH TECH (SUPERIOR COVERAGE ONLY)
HYBRID (SUPERIOR, SECURE PLUS COVERAGES ONLY)
The purchaser acknowledges that this Application Page and Terms & Conditions together with any Identification Card constitute the entire Vehicle Service Contract. The Coverage I
have selected expires according to the terms indicated on the Application page and Identification Card as defined in the Terms & Conditions, Coverage Period Section. The components
and parts covered are listed under the Terms and Conditions, Schedule of Cove
rage Section. I agree to maintain the Vehicle in accordance with the Terms & Conditions, Contract
Holder’s Maintenance Requirements Section. I understand to file a claim in the event I have a Breakdown, I am to follow the instructions in the Terms & Conditions, Filing a Breakdown
Claim Section. This Contract is neither an insurance policy nor a seller’s warranty. This Contract may run concurrent with and is secondary to a
ny applicable manufacturer’s warranty.
Purchase of this Contract is not required in order to purchase or lease a vehicle or obtain vehicle financing.
I have reviewed and understand the time and mileage limitations, coverage, and exclusions, and that the repair of non-covered components is excluded from Coverage. I have reviewed
all the Coverage and options available. All of the options I wish to purchase are clearly marked above. I have read and understand the
Terms and Conditions, Contract Holder’s
Responsibilities of this Contract Section. I hereby declare that I have received the Contract and the above information is correct. I UNDERSTAND THAT THE CONTRACT WILL BE
BETWEEN THE ADMINISTRATOR (Endurance Dealer Services, LLC) AND APPLICANT.
OR
OR
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