First Name: Last Name: Street Address: City: State: choose one... Alabama Alaska Arizona Arkansas Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code:   Work Phone: Ext. Home Phone: Email Address: Make: choose one... Acura Audi BMW Buick Cadillac Chevrolet Chrysler Daewoo Dodge Eagle Ford Geo GMC Honda Hummer Hyundai Infiniti Isuzu Jaguar Jeep Kia Land Rover Lexus Lincoln Mazda Mercedes-Benz Mercury Mini Mitsubishi Nissan Oldsmobile Plymouth Pontiac Porsche Saab Saturn Scion Subaru Suzuki Toyota Volkswagen Volvo Model: Year: choose one... 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 Approx. Mileage: choose one... 0 - 4,999 5,000 - 9,999 10,000 - 14,999 15,000 - 19,999 20,000 - 24,999 25,000 - 29,999 30,000 - 34,999 35,000 - 39,999 40,000 - 44,999 45,000 - 49,999 50,000 - 54,999 55,000 - 59,999 60,000 - 64,999 65,000 - 69,999 70,000 - 74,999 75,000 - 79,999 80,000 - 84,999 85,000 - 89,999 90,000 - 94,999 95,000 - 99,999 100,000 - 104,999 105,000 - 109,999 110,000 - 114,999 115,000 - 119,999 120,000 - 124,999 125,000 - 129,999 130,000 - 134,999 Year Purchased: 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 New or Used: New Used Engine Cylinders: 3 4 6 8 10 12 Approx. Purchase Price: $0 - $4,999 $5,000 - $9,999 $10,000 - $14,999 $15,000 - $19,999 $20,000 - $24,999 $25,000 - $29,999 $30,000 - $34,999 $35,000 - $39,999 $40,000 - $44,999 $45,000 - $49,999 $50,000 - $54,999 $55,000 - $59,999 $60,000 - $64,999 $65,000 - $69,999 $70,000 - $74,999 $75,000 - $79,999 $80,000 - $84,999 $85,000 - $89,999 $90,000 - $94,999 $95,000 - $99,999 $100,000 - $104,999 $105,000 - $109,999 $110,000 - $114,999 $115,000 - $119,999 $120,000 - $124,999 $125,000 - $129,999 $130,000 - $134,999 Diesel 4x4/AWD Turbo/Supercharged Best Time To Reach You: choose one... Call Now at Work Phone Call Now at Home Phone Call in Morning at Work Phone Call in Morning at Home Phone Call in Afternoon at Work Phone Call in Afternoon at Home Phone Call in Evening at Work Phone Call in Evening at Home Phone Does the vehicle have at least 1000 miles and 1 month of factory warranty remaining? Yes No

WHY CHOOSE AUTO WARRANTY GROUP?

Our Goal:

Always at least 50% less than all Automobile Dealers

End of Confusion

Thousands of policies and administrators, too many confusing choices. We use our proprietary technology to sort through the mass of confusing and conflicting information. Length of contract, type of vehicle, mileage of vehicle, parts covered, vehicle history, and your budget are just the start. From all of this information we produce better choices, better options, all adding up to better value for you our customer.

Instant Coverage

Backed by our own team of CARCHEX inspectors, we can arrange for coverage with no exclusions almost instantly. Our CARCHEX inspectors come to your location, at your convenience, to review the vehicle. This CARCHEX inspection is your key to instant coverage.

Great Pricing

Most people buy their warranties from an Automobile Dealer. At the dealer there is no choice, no negotiating and lots of pressure. We always deliver better, more comprehensive coverage at prices at least 50% less, everyday!

100% Money-back Guarantee to Consumer*

That's right - if no claims are made during the term of the policy we return 100% of your premium.

*Money back Guarantee program not available in Florida, Louisiana, Michigan, Washington, Wisconsin and Wyoming.

Pick Your Own Repair Facility

More than 30,000 available. Auto dealers, Goodyear, NTB or you local mechanic – You choose, close and convenient.

Our Experts

Our claim specialists will help you through the repair process. Their expertise and mass buying power insures you, our customers get the right repair at the right price. You never have to negotiate with the shop again!

We Accept:

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October 10th, 2008