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Material Request Form

Material Request Form

This package is being sent to *

Name *

Email *

Phone *

Account Manager Name

Account Manager Email

SHIPPING INFORMATION

Dealership Name *

Attention *

Phone

Street Address *

Suite Number, Apartment Number, etc.

City *

State *

Zip Code *

Special Shipping Instructions (ie. warehouse, residential, etc.)

*Digital materials are available on zoom.alphawarranty.com

BROCHURES

PriorityOne Unlimited

A+

A La Car

Alpha Tiered

ABC

New Car

What is a VSC

Classic GAP 125%

Classic GAP 150%

DriveEasy Wrap

DriveEasy Warranty

ElevateCare Bundle

Key/Remote Replacement

Tire And Wheel

Do you need dealer mats?

YES

NO

DEALER MATS

PriorityOne Unlimited

A Plus

A La Car

Alpha Tiered

ABC

New Car

SALES KITS

CREATE YOUR OWN PRESENTATION KITS

The Sales Kits provided will include Dealer Profile, Dealer Agreement, Claims and Limits of Liability Booklet, Core Programs Booklet, Specialty Programs Booklet, Ancillary Booklet, and PriorityOne Unlimited Sample Contract.

Quantity

What states are you selling in?

If you would like Rate Cards and/or Brochures in your Sales Kits, please select all that apply to you.

Rate Cards:

*Your standard rates will be sent unless otherwise specified.

PriorityOne Unlimited Program

A+ Program

A La Car Program

ElevateCare Program

Tire & Wheel

Alpha Tiered Program

ABC Program

New Car Program

Key/Remote Replacement

Brochures:

PriorityOne Unlimited Program

A+ Program

A La Car Program

ElevateCare Program

Tire & Wheel

Alpha Tiered Program

ABC Program

New Car Program

Key/Remote Replacement

DRIVEEASY SALES KITS

The DriveEasy Sales Kits are not customizable. Each kit will contain the DriveEasy Dealer Profile, Agreement, Sample Contracts, Brochures, and Rate Cards.

Quantity

States Selling In

SPECIAL REQUESTS

*Please state any other items needed and the quantity.

Thank you for your Material Request. If you have any questions please contact us at 1-800-662-5519 Ext. 6.

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Coverage Lookup

Please select if you are an Agent/Dealer or Customer/Repair Facility from the options below.

If you are a customer please call 800.662.5519 to start a claim.

If you are a repair facility please use our online claim form or call 800.662.5519 to submit a claim.

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