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NATJONAL VEHICLE SERVICE CONTRACT APPLICATION, TERMS & CONDITIONS (All Vehicles up to and Including Transit and F SSO series) REGISTRATION INFORMATION Vll hl cle .ldentifiOltlon Num b e r I l i F I T I 7 1 w I 2 1 B I 6 1 8 l G I E l Cl2 l s i 1 1 1 j 3 [ Internet Sale I Current Mileage D Yes ~ No 56 RECEIVED KITT IT AS COUNTY SHE RI FF ACCOU N IN G Signature Date Warra nty Start Date 05/04/2016 03/25/2016 Current Hours" IPP Term D I ~ I FORD PROTECT DCPO D Incomplete (CablChassis) I D Limo/Livery Wrap Surcharges: D 12 Monthsll 2,000 Miles D TurbochargerlSupercharger D Snowplow ~ Commercial Use D Specialty -Emergency (Fire, Ambulance, Police pursuit units -except Ford police interceptor), Limo, Livery, Shuttle, Tow Truck) D com~onent Wrap ( on-CPO) New Plan Coverage: Co re· PowertralnCARE. B~5eG.tlRe. Extra~RE, PremiumCARE (Stand~rd Deductib le Is $100) Leafll CARE -NewPrem iUmC ARE wlth Wear Items on Rl rd and linco ln vehicles · (Sta ndard Deductible is $0) Rental Care · (RentaICARE-Standard Deductible Is $0) Super Duty Coverages· (Diesel EngineCARE, Diesel EngineCARE Plus -Standard Deductible is $100) Used Plan Coverage: Core (PowertrainCARE, BaseCARE, ExtraCARE, PremiumCARE -Standard Deductible is $ 1 00) PLAN COVERAGE (8J New Plan D Used Plan Plan Name A Deductible Plan Term Plan Expiration -(Earliest of all 3) Purchase Months Mileage Hours" Date Mileage Hours" Price PremiumCARE $100 60 1125 ,000 I 03/25/2021 1125,000 I $ 3,540.00 SalesTu Total Purchase Price with SalesTax $ 304.44 $ 3,844.44 Options D Fi rst Day Rental Delete D Enhanced Rental D InterlorlExterior Lighting Delete Plan NameB Deductible Plan Term Plan Expiration -(Earliest of all 3) Purchase Sales Tax Total Purchase Price Months Mileage Hours" Date Mileage Hours" Price with SalesTax I I I I $ $ $ Options D First Day Rental Delete D Enhanced Rental D InteriorlExterior Lighting Delete "Super Duty Coverages and Incomplete Vehicle Plan Coverages require Current Hours and I Expiration Hours for all vehicles with an hour meter. Total $ 3,540.00 $ 304.44 $ 3,844.44 DISCLOSURE INFORMATION THE PURCHASE OFTHIS AGREEMENT IS NOT REQUIRED IN ORDER TO PURCHASE, OR OBTAIN FINANCING FOR A MOTOR VEHICLE. YOU MAY PURCHASE THE SERVICE CONTRACT BY CASH OR UNSECURED CREDIT CARD. IF YOU ELECT TO PURCHASE THIS AGREEMENT. IT GIVES YOU SPECIFIC LEGAL RIGHTS. WHICH MAY VARY FROM STATE TO STATE. I ac~nowled.ge recelp.t of a complete copy of this Applica tion and the remis and ConditionS (the "En tIre Agreemenl'1 ilt the time of signing and agree to all the terms and conditions. I agree 10 maintain the covered vehl t le In acco rdance wltl1 the manuFi\cturer's 5tated perlo'dlc maintena nce recommendations as a condition of receiving coveraoe under Ihls Acreemenl.exc.ebt as otherwise orov [ded bv law_ Mississippi Residents Only: By signing below, I agree to Washington Residents Only: By Initialing this box, I acknowledge I have reviewed with Dealer the the binding arbitration language in the Mississippi Section . section of this Service Contract titled, What This Agreement Covers and What is Not Covered, Your d Responsibilities for Care of the Vehicle, Implied Warranty of Merchantitfbility and Your and Our Rights to Cancel Agreement. SIg nat u re (not valid without Sig n at ure) SERVICE CON TRACT HOLDER I PURCHASER Signature INot Va lid without Slgna·t\lre) \ \ lI / ~t (f (jJ Signature Date Origi ~:k l n'IT~r;f I CE~1 ' 05 /0412016 _. ~ 'c/ -"( V~ Name Address KITTITAS COUNTY SHERIFF'S OFFICE 307 UMPTANUM RD City I State .1 Zip Code E-mail Address Service Contract Lienholder Name ELLENSBURG WA 98926 DEALERSHIP INFORMATION...---) // Deillersh~S lgnature~~ Original igned by : BEN VIDOU RE /7 Dealer Name ~ Corwin Ford Tri-Cities Address 1 Address 2 1 225 North Autoplex Way Cily state Pasco WA FOR OFFICE USE ONLY Zip Code Telephone No 99301 Em~lo~eeS tars Id P&A~ode I I I I I I I I I I r 0 ! 6 I 4 I 6 I 7 [ ESP 8240-Nat App/Provs (Oct 15 ) (Previous Editions May Not be Used)