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F <br />4 - <br />NATIONAL VEHICLE SERVICE CONTRACT <br />APPLICATION, TERMS & CONDITIONS <br />(All vehicles up to and including Transit and F-550) <br />RFGISTRATIii INFORMATION <br />RECEIVED <br />KITTITAS COUNTY SHERIFF <br />ACCOUNTING <br />W " N CCL N <br />PROTECT <br />�n �­z <br />Vehicle Identificatlon_Number <br />Signature Date <br />Warranty Start bate <br />CPO <br />I F M 5 K, R 9 1 H G C 8 1 7 <br />1 3 <br />3 <br />3/ <br />Date Mileage Hours* <br />Price <br />Address T <br />with Sales Tax <br />07/13/2017 <br />05/30/2017 <br />100000 <br />Internet Sale <br />R Yes L5C] No <br />Current Mlleage� <br />226 <br />Current Hours* <br />IPP Term <br />�� <br />r� Incomplete <br />L_J <br />$ 289.80 <br />$ 3739.80 <br />Options First Day Rental Delete [:] Enhanced Rental Key Services Delete (New Plans only) [:] Interior/Exterior Lighting Delete (New Plans only) <br />(Cab/Chassis) <br />__ _� <br />Surcharges : <br />12 Months/12,000 Miles EJ 36 months/36,000 miles (Ford and Competitive Make or 48 months/50,000 miles (Lincoln vehicles) <br />E] Limo/Livery Wrap <br />Turbocharger/Supercharger ❑ Snowplow Q Commercial Use D Specialty - Emergency (Fire, Ambulance) <br />Component Wrap <br />Ix] Specialty - Emergency (Fire, Ambulance, Police pursuit units - except Ford Police Interceptor), Limo, Livery, Shuttle, Tow Truck) <br />(Non -CPO) <br />wry wvvvcuyc vic -- , ♦t-, u... L, Ln [o V/'�Z, r lCllllulll V/"1R G kokaiivaiu ueuuuuuie iZ5 y iuv) <br />LeaseCARE - New PremiumCARE with Wear Items - (Standard Deductible is $0) <br />Rental Care - (RentaICARE- Standard Deductible is $0) <br />Super Duty Coverages - (Diesel EngineCARE, Diesel EngineCARE Plus - Standard Deductible is $100) <br />Used Plan Coverage: Core (PowertralnCARE, BaseCARE, ExtraCARE, PremiumCARE - Standard Deductible is $100) <br />PLAN COVFRAGF FX1 New Plan n Used Plan <br />Plan Name A Deductible <br />Plan Term <br />Plan Expiration - (Earliest of all 3) <br />Purchase <br />Sales Tax <br />Total Purchase Price <br />-47-/ 3/ W-71— <br />Months Mileage Hours* <br />Date Mileage Hours* <br />Price <br />Address T <br />with Sales Tax <br />PremiumCARE $0 <br />60 <br />100000 <br />Zip Code <br />05/30/2022 <br />10000Q <br />E-mail Address e Contract <br />$ 3450.00 <br />$ 289.80 <br />$ 3739.80 <br />Options First Day Rental Delete [:] Enhanced Rental Key Services Delete (New Plans only) [:] Interior/Exterior Lighting Delete (New Plans only) <br />Key Services Opt -1n (Used Plans only) interior/Exterior Lighting Opt -In (Used Plans only) PDL (Lincoln Only) <br />Plan Name B <br />Deductible <br />Plan Term <br />Plan Expiration - (Earliest of all 3) <br />Purchase <br />Sales Tax <br />Total Purchase Price <br />Months Mileage Hours* <br />Date Mileage Hours* <br />Price <br />with Sales Tax <br />$ — <br />$ <br />$ -- <br />Options F—]First Day Rental Delete [:]Enhanced Rental Key Services Delete (New Plans only) E] Interior/Exterior Lighting Delete (New Plans only) <br />Key Services Opt -In (Used Plans only) Interior/Exterior Lighting Opt -In (Used Plans only) ❑ PDL (Lincoln Only) <br />*Super Duty and Incomplete Vehicle Plan Coverages require current hours and expiration <br />hours for all vehicles with an hour meter. <br />Total 1$3460.00 <br />$289.80 <br />$ 3739.80 <br />uio%.#Lvaur« uvrvimmmi liviv: <br />THE PURCHASE OF THIS AGREEMENT IS NOT REQUIRED IN ORDER TO PURCHASE, OR OBTAIN FINANCING FOR A MOTOR VEHICLE. YOU MAY <br />PURCHASE THE SERVICE CONTRACT BY CASH OR UNSECURED CREDIT CARD. IF YOU ELECT TO PURCHASE THIS AGREEMENT, IT GIVES YOU <br />SPECIFIC LEGAL RIGHTS, WHICH MAY VARY FROM STATE TO STATE. I acknowledge receipt of a complete copy of this Application and Terms and <br />Conditions (the "Agreement") at signing and agree to all the terms and conditions. I agree to maintain the covered vehicle in accordance with the manufacturer's <br />stated periodic maintenance recommendations as a condition of receiving coverage under this Agreement, except as otherwise provided by law. <br />Mississippi Residents Only: By signing below, I agree to the Washington Residents Only, By initialing this box, I acknowledge I have reviewed <br />binding arbitration language In the Mississippi Section. with Dealer the section of this Service Contract titled, What This Agreement Covers <br />and What Is Not Covered, Your Responsibilities for Care of the Vehicle, Implied <br />_ — <br />Signature (not valid without Signature) Warranty of Merchantitibility and Your and Our Rights to Cancel Agreement. <br />RFR\/IRF r'-r)KITRAr'_T whi him / 5NPr`WAQ1=R <br />Signature (Not Valid without Signature) <br />Signature Date <br />Ford, Ford, Inc. <br />Address 1 <br />-47-/ 3/ W-71— <br />700 -7th Avenue <br />Name <br />Address T <br />State <br />KITTITAS COUNTY <br />WA <br />307 W UMPTANUM RD <br />Zip Code <br />City <br />�Sttaate Zip <br />E-mail Address e Contract <br />Lienholder Name <br />ELLENSBURG <br />`6 <br />NONE <br />_0 8 6 0 2 <br />ur�a� r'K�r11N n�ri 1Kam�a � n n� <br />Dealership Signature <br />- ... <br />Dealer NameColumbia <br />Ford, Ford, Inc. <br />Address 1 <br />Address 2 <br />700 -7th Avenue <br />City T <br />State <br />Longview <br />WA <br />Zip Code <br />Telephone No <br />98632 <br />Employee Stars Id <br />P&A Code <br />0 I0 1 2 1 4 L 7 7 j 6 1 4 <br />_0 8 6 0 2 <br />ESP 8240 -Nat App/Provs W/Key(July 17) (Previous Editions May Not Be Used) <br />L <br />