Affordable Cooling & Heating Service

Please Enter Your Informatiom To Purchase a
Residential Annual Preventative Maintenance Agreement, With Your Credit Card,
Fill In the Information Below and Press Submit Button.
Annual Residential
Preventative Maintenance Agreement (PMA)
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, (PMA).
$139.95 for Air Conditioning Systems, With 1 LB R-22 Refrigerant.
$179.95 for Heat Pump Systems, With 1 LB R-22 Refrigerant.
(IF ADDITIONAL REFRIGERANT IS NEEDED
AN ADDITIONAL CHARGE WILL APPLY PLUS TAX.)
Quantity of Air Conditioning Systems:
Located on Roof, In Crawl Space or Attic?:
Located on Roof, In Crawl Space or Attic?:
Quantity of Heat Pump Systems:
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

(816)
468-1509

IF YOU PREFER TO MAIL IN YOUR ANNUAL PAYMENT
(Credit Card, Check or Money Order)

PRESS THIS (BLUE CLICK HERE Button)
TO PRINT A SIGN-UP FORM





SIMPLY, FILL OUT THE FORM AND MAIL IT TO:

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

CLICK HERE
for
PMA FORM

CLICK HERE
for
PMA FORM