Sample Application For Your Honda Care Extended Warranty
 

Application for Coverage

Honda Care™ for Honda Vehicles is administered by American Honda Finance Corporation P.O. Box 2225, Torrance, CA 90509-2225, 1-800-999-5901

First

Honda Care™ for Non-Honda Vehicles is administered by Automobile Protection Corporation (APCO) P.O. Box 88230, Atlanta, GA 30356, 1-800-661-3279

Last

Print VSC Salesperson's Name (Please print or type)

For Roadside Assistance, call 1-800-594-7400

Issuing Dealer	Dealer Number	VSC Plan Type:
	Dealer Phone	q	New
	(   )	q	Pre-Owned*
VSC Customer Retail Price $__________	Deductible	q	Sentinel*
		q	Certified*
Plan Code           Years             Miles	$
			*Must be acquired at time of vehicle purchase.

Vehicle Information

Vehicle Retail Price $ ____________________

Stock# _________

V.I.N.

Make	Model	Year
Current Odometer Mileage	VSC Retail Date	Vehicle Original Retail Date (Non-Honda Vehicles Only)

Customer Information

Name (First)	(M.I.)		(Last)
Co-Owner Name (First)	(M.I.)		(Last)
Address
			(      )
City	State	ZIP	Phone

Lienholder/Lessor  (Complete only if contract is financed or leased)

Lienholder Name	Term (Mo.)		Type (C=Cash, F=Finance, L=Lease)
Address
			(      )
City	State	ZIP	Phone

Important: Coverage for a New, Sentinel or Certified plan begins when the vehicle is originally put into service and at zero miles.  Coverage for a Pre-Owned Plan begins on the vehicle purchase date and at the mileage on the odometer on that date.  Attached is an example Vehicle Service Contract that outlines the various coverages available.  Refer to your personalized Vehicle Service Contract for you coverage, expiration date and miles.

This Vehicle Service Contract application is subject to approval or rejection by the administrator.  If you have not received your Vehicle Service Contract within 30 days of the date of this application, please call 1-800-999-5901 or forward a copy of this application to: American Honda Finance Corp., VSC Customer Relations, P.O. Box 2225, Torrance, CA 90509-2225.  Your coverage is not subject to any verbal representations made by your dealer.  The purchase of this contract does not waive any implied warranties that are available to you, an purchase of this contract is not a requirement to purchase, obtain financing or to register a motor vehicle.  This is not an automobile liability insurance contract.  We do not disclose information about our customers to anyone, expect as permitted by law.

_______________ Customer's Initials

 

Customer's Signature

Date

Dealer's Signature