Affordable Cooling & Heating Service
To Purchase a
Residential Annual Preventative Maintenance Agreement, With Your Credit Card,
Please Fill In the Information Below and Press Submit Button.
Click Here to
Print a
Residential
Annual
Preventative
Maintenance
Agreement   
Sign Up Form
RESIDENTIAL Annual Preventative Maintenance Agreement
Request or Sign-Up Form
Your First Name:
 Your Last Name:
Street Address:
 2nd Street Address:
City:
 State:
 Zip Code:
Home Phone Number:
 Work  Phone Number:
Cell Phone Number:
 Your E-mail Address:
I am Purchasing an Annual Residential Preventative  Maintenance Agreement.
$139.95 for Air Conditioning Systems and/or $199.95 for Heat Pump Systems.
Quantity of Air Conditioning Systems:
 Located on roof,in crawl Space or Attic?:
 Yes or No
Quantity of Heat Pump Systems:
 Located on roof,in crawl Space or Attic?:
 Yes or No
My Credit Card Number:
 Expiration Date:
 (example:  01/08)
Type of Credit Card:
 (VISA or MasterCard Only)
 CVV2 Number:
Comments: (Example:)
Request to purchase an Annual Preventative
Maintenance Agreement  for 2009.
When Mailing Payment With Credit Card Information, Check or Money Order,
Please Print and Fill out a
Residential Preventative Maintenance Agreement Sign-Up Form.

Mail Form and Payment to:
Affordable Cooling & Heating Service,  PO Box 28856,  Kansas City, MO  64118
(816)
468-1509
or
(816)
459-7977