Affordable Cooling & Heating Service

Please Enter Your Informatiom To Purchase a
Residential Annual Preventative Maintenance Agreement, With Your Credit Card,
Please Fill In the Information Below and Press Submit Button.
Residential Annual Preventative Maintenance Agreement
Credit Card Purchase Entry Form
Your First Name:
 Your Last Name:
Street Address:
2nd Street Address:
State:
 Zip Code:
City:
Home Phone Number:
 Work  Phone Number:
Cell Phone Number:
 Your E-mail Address:
I am Purchasing an
Annual Residential Preventative  Maintenance Agreement.
$299.95 for Air Conditioning Systems, With Refrigerant.
$369.95 for Heat Pump Systems, With Refrigerant.
$199.95 for Air Conditioning Systems, without Refrigerant.
$269.95 for Heat Pump Systems, without Refrigerant.
Quantity of Air Conditioning Systems:
 Yes or No
Located on roof,in crawl Space or Attic?:
Quantity of Heat Pump Systems:
 Yes or No
Located on roof,in crawl Space or Attic?:
Please Enter Your Credit Card Information.
Type of Credit Card:
 Expiration Date:
 (example:  01/08)
(American Express not Accepted).
CVV2 Number:
My Credit Card Number:
Do You have questions or comments?
Comments: (Example:)
Request to purchase an Annual Preventative
Maintenance Agreement  for 2012.
For More
Information.
About PMA's
 
Call Our
OFFICE at

(816)
468-1509
Our
Mailing
Address is
Located at
the Bottom
of This
Page.
When Mailing Payment With Your:
(Credit Card, Check or Money Order)

Press the Blue CLICK HERE Button, to Print a:
Residential Annual Preventative Maintenance Agreement Sign-Up Form





Please, Fill Out the Form:

Mail Completed Form and Payment To:

Affordable Cooling & Heating Service
P.O. Box 28856
Kansas City, MO  64118

CLICK HERE for
PMA FORM

CLICK HERE for
PMA FORM