INSURANTEE® REQUEST FORM FOR PROTECTION ON DEPOSIT, PRODUCT AND INSTALLATION.

Fill out the form below and hit Enter. This will send your request for on-line Insurantee® registration to our headquarters.

Remember: Only authorized dealers have been approved to offer Insurantee® protection. It is your assurance that they are providing the finest products and services to you. If you're a homeowner, Insurantee® is a free service provided by your dealer. We will need to confirm his payment before we can issue the DPN number.

If you're a dealer, the BSN Number on the application is your access number to the policy you're providing your customer.

Within 24 hours, you will have an e-mail confirmation of your unique Deposit Protection Authorization Number (DPN) which will be your password number to view your registration confirmation on-line. The registration number is also your identity number if you have any questions or problems.

Description of Home Improvement Job

 BSN Number Now is the

Date

 Representative Number

 Contract Value

 Deposit Amount

 Manufacturer

 Home Owner Name

 Home Address

 City State Zip

 Phone   Fax

 e-mail

  Now i to getr

 

Insurantee® Program
AWDI, LLC
11300 US HIGHWAY ONE-SUITE 400
NORTH PALM BEACH, FL 33408
561-625-6030 FAX 561-776-9827