Home Warranty Application Broker One

Online Form

Home Warranty Application- Broker One


(Format: DD/MM/YYYY)

Acceptance of Coverage:

Applicant acknowledges that he/she understands the terms and conditions of coverage and authorizes closing agent
to pay the required fees upon closing.
(Format: DD/MM/YYYY)
*Agents; if your client is not available to type in their own name, you may do so for them with the acknowledgment that you do so with their understanding and permission.

SELLER Information

From (Format: DD/MM/YYYY)
To (Format: DD/MM/YYYY)

BUYER Information

Real Estate Agent Information

Closing Information (if available)

*Contact name and email must be filled out for this form to be sent automatically to closing company.

Covered Items

Buyer’s Coverage Levels
Basic $450
Premium $525
NEW! Unknown Pre-Existing Conditions
Unknown Insufficient Maintenance
Heating System/Furnace (1 unit)
Air Conditioning System/Cooler
Plumbing System
Stoppages/Clogs and sewer line cleaning
Permanent Sump Pump
Water Heater Including Tankless
Instant Hot Water Dispenser
Whirlpool Bath Tub
Electrical System
Ceiling Fans and Exhaust Fans
Door Bells, Burglar & Fire Alarm Systems
Central Vacuum
Built-In Microwave
Trash Compactor
Garage Door System
Septic Tank Pumping
Well Pump
Kitchen Refrigerator w/ Ice Maker
Washer/Dryer Package
Premium Coverage **


Select your Coverage

Mother-in-law Units/Multiple Flats/Duplex/or over 5,000 sq. ft. Call 307-995-3530 for pricing
•NEW! Water Softener
•NEW! 13 SEER/R-410A Modifications
•NEW! Preventative Maintenance Check and Cleaning
•Unknown improperly matched and/or installed system
•Increases professional series appliances up to $2,500
•Increase toilet repair up to $600
•Removal of defective equipment
** Premium Coverage: includes coverage for over 30 items traditionally not covered by basic home warranty plans. *Code Violations and Permits up to $250 *Plumbing – Fixtures, faucets, shower heads and shower arms *Over 25 more items!

Coverage is subject to a standard deductible/service fee of $75 (or the actual amount, if less) per service call per trade agent at time of service call. Additional charges may apply to certain repairs or replacements. Homeowner’s coverage begins when payment has been received.

You will not be reimbursed for work performed
without prior 1Warranty, Inc. approval.
For Claims Service Call 1-800-261-1025

The contents of this form will be emailed to you, the indicated title company and 1Warranty, Inc. after submission so you will have it for your records.


All Escrow/Title Payments can be made out to 1Warranty, Inc. and sent to: PO Box 50671 Casper, Wy 82605. For Direct Payment Please Call Customer Service at: 307-995-3545. Please have your credit card ready.