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��'��s�,,,�� ��-r.� <br /> pj,Q�O �� t'scense # CFC04b00 •�� <br /> � I . • <br /> A�'i`+LC Ctlt � <br /> , ;: <br /> • <br /> � , ' j ��,...� <br /> T�IEPUNClUAL PLUIVIB�Rm <br /> 1-866-�fi7-8309 • www.benfranl�.tintampabay.com <br /> �, q`�`��► �, 2 �iZ.`� <br /> , Custom�,e�r Na e ���� �� Date Work Order <br /> °Address <br /> Z� �c ��.s � � 35�- `�. <br /> Gty State Zip <br /> �j ..�- ����� <br /> Home Phone Cell Phone Email <br /> Minimum Service Fee <br /> `�iz"°" Emergency- $99.00 <br /> We hereby pr.opose to complete as specified the following: <br /> c°".'°'` Reserved - $69.00 <br /> We will rovide you with multiple options c°".'"'`. ,Standby - $49.00 <br /> � ^�'`� �., � •, � ��i..,. -�-�' '�... <br /> , <br /> ; � �3 r ,�. � . .�/"�`"1� <br /> r <br /> r^"""^� i. <br /> �..- -�c���.. r �� �� �.,�.:� �, ? `� � ��� � <br /> Z_ �� �� �, �`�--e.�- �- �.��-� . <br /> �. ��`� `.�` ,,�.��-�1 <br /> � � <br /> �-1� `� �Z...�15� <br /> � ��u � <br /> � �n ��..,� � ° �.� �l <br /> � � , � . <br /> � � . . • . � � <br /> My p ofessional technician has offered me all of these other services that Benjamin Franklin provides. <br /> Water Heater $ � Decline Protect My Plumbing System ❑Yes $27.99 ❑ Na <br /> inrUa s <br /> Wate Treafiment $ � Decline Protect My HVAC S.ystem OYes $26.99 D No <br /> mUa s <br /> DEEP P1an # � Pratect My Water Neater ❑Yes $7.99 ❑ No <br /> Pleas check add on services if needed: O Multi Discaunt $50.38 <br /> Carp nter ❑ $400.00 ❑ $750.00 ❑ ! decline Safet Ins ection (lnitiaC) <br /> Electr cian ❑ $5Q0.00 ❑ $95Q.00 Y A <br /> � <br /> AYMENT METHQDI�INANCE OPT[ONS INVESTMENT AMQUNT $ <br /> O C SN ❑ CNECK ❑ CNARGE ❑ FINANCE PROMOTION � � �- $ - <br /> WELLS FARGfJ SYNCHRONY SNAP UTILITY REBATE $ - <br /> PAYME T FACTOR % DEPOSIT $ -- �ti��`���i-�� � <br /> EST. M(�7NTHI..Y PAYMENT $ TOTAL $ <br /> ` � <br /> PLAN # /AUTH # �, ' �� ��'� $ � `� � <br /> � <br /> � <br /> � WATER HEA ER: MODE�"# SERIAL # <br /> f '1 �' j . �� �� . �. <br /> � Acceptanc : ' �1�,� .� Authorization: / Date:__��._.,. <br /> ; � CUSTOMER COMPANY <br /> i DECLINE: <br /> i � <br /> ' *FI.EASE SEE AGREEI3 COtV[}IT10NS QN SACK* <br /> i <br />