PLUMBING • HEATING & COOLING • FUEL OIL 247 Main Street, Harleysville PA 19438 215-256-4221 www.itlandes.com SERVICE PLAN ENROLLMENT / RENEWAL INVOICE Customer Name & Service Address: _____________________________________ _____________________________________ _____________________________________ Invoice# Account# Job Address (if different): _____________________________________________________________________________________ Gold Shield Oil Burner Service Plans Please choose or make changes to your coverage below: QTY Service Agreement Plans * Available to Automatic Oil Customers Only Price Per Amount Unit Due Gold Shield Base Oil Plan: Includes one annual maintenance/cleaning on burner. Also includes repair discounts and priority scheduling as outlined in brochure. $ 255.00 $ $ 345.00 $ $ 155.00 $ $ $ Gold Shield Premier Oil Plan: Includes one annual maintenance/cleaning on burner in addition to priority scheduling and parts and labor coverage for items as outlined in brochure. Labor discount will apply to parts not covered. Optional Add-On to Plans Oil Fired Water Heater: Includes one annual maintenance/cleaning for your separate oil fired water heater, performed during burner cleaning visit. Additional Zone Coverage: Per zone (for systems with 2 or more heating zones) *In Conjunction with Premier Oil Plan only. Please note location of covered thermostats. 25.00 TOTAL AMOUNT DUE $ Contract Effective Dates _______ _________ start end  Please begin coverage on plan(s) as marked above.  I have read and agree to all of the terms and conditions of the service plan as outlined in the brochure.  I understand and agree that I.T. Landes retains the right to make necessary repairs and replacement to parts NOT covered by the contract in order to insure the safe and optimum operation of my heating system.  Please bill my credit card MasterCard / Visa / Discover #_______-_______-_______-_______ Exp.______ Code____  Please roll my contract renewal into my budget oil delivery plan (must be currently enrolled in budget program). ► Customer Signature:________________________________________ Date:________________ Please sign and enclose check payment or choose payment option above in order to begin coverage. ALL PLAN COVERAGE MUST BE PUT INTO PLACE PRIOR TO ANY MAINTENANCE OR SERVICE DONE UNDER CONTRACT