Full Name
Property Address
Best Contact Email
Best Contact Phone
Approx. Age of Item
Description of Issue
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Assertive Home Warranty
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1. Contact Information
Full Name*
Property Address*
Email Address*
Best Contact Number*
2. Incident Details
Affected Item*
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Heating / AC
Plumbing System
Electrical System
Kitchen Appliance
Washer / Dryer
Other
Item Age (Years)
Description of Failure*
3. Supporting Documentation
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