KOHLER AIR COOLED MAINTENANCE SERVICE AGREEMENT "*" indicates required fields Name* Email* Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Options(select one)- 2023 1 year maintenance agreement - $275.00 (This price includes one (1) basic preventive maintenance service [one per year]. It does not include a battery replacement.) We are no longer accepting 1-year Maintenance Agreements for 2023.- 3 year maintenance agreement - $825.00 (This price includes three (3) basic preventive maintenance services [one per year] including one (1) battery replacement, as needed, or on the third (3rd) year.)Select your plan:* Select 3 year plan - $825.00 Maintenance Preferences: (select one in each column) *see Terms and ConditionsMonthNo PreferenceMarchAprilMayJuneJulyAugustSeptemberOctoberIf a specific month is preferred, please select it here. All preferences are taken into consideration; no preference is guaranteed.Day of weekIf a specific day of the week is necessary, please provide it here. Due to scheduling purposes, this day of the week is not guaranteed; however, we will do our best to accommodate that preference.No PreferenceMondayTuesdayWednesdayThursdayFridayConsent to Services:Check each one to "initial" I agree - Battery Cost ClauseIf the one (1) year maintenance agreement option was selected, I authorize MGS to replace the battery (as needed) while on site performing maintenance. Cost of battery, at that time, will be $125.00. An invoice for the battery replacement will follow within seven (7) days from the date of maintenance. I agree Terms and Conditions*I accept and agree to all Terms and Conditions as detailed in this Maintenance Service Agreement. I agree I agree - Power off ClauseI authorize MGS to turn off power to my home during the testing of my generator unit. (This is not a requirement; however, it is recommended.) I agree This Maintenance Service Agreement is a contract between client and Midwest Generator Solutions consisting of essential preventive maintenance for client’s Kohler air cooled generator. Warranty and repairs are not included in this maintenance service agreement and are considered repair service. Repair service shall be billed to the client, and payment is expected upon completion. If the one (1) year option is chosen, the term of this agreement shall end December 31st of the first (1st) year. If the three (3) year option is chosen, then the term of this agreement shall end on December 31st of the third year. This agreement shall not renew automatically. Prices are subject to change without notice. No claim of damages due to termination shall arise against either party. If contract is prematurely terminated, fees are non-refundable. Date* MM slash DD slash YYYY Client Signature* Please put name herePayment InformationTotal Credit Card Information American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged. CONTACT US! We Sell, Install and Service Generators Client Name PhoneEmail Message
