AGREEMENT # Windshield Protection VEHICLE SERVICE AGREEMENT Schedule Page AGREEMENT HOLDER EMAIL ADDRESS ADDRESS TELEPHONE CITY STATE ZIP CODE SELLER SELLER CODE ADDRESS TELEPHONE CITY STATE ZIP LIENHOLDER ADDRESS TELEPHONE CITY STATE ZIP ODOMETER MILEAGE ON AGREEMENT PURCHASE DATE VEHICLE PURCHASE PRICE AGREEMENT PURCHASE DATE AGREEMENT PURCHASE PRICE AGREEMENT TERMS OF PAYMENT: PAID IN FULL PAYMENT PLAN FINANCED LEASED YEAR MAKE MODEL VEHICLE IDENTIFICATION NUMBER THIS IS NOT AN AUTOMOBILE PHYSICAL DAMAGE OR AUTOMOBILE LIABILITY INSURANCE CONTRACT. YOU ARE NOT REQUIRED TO ENTER INTO THIS AGREEMENT IN ORDER TO PURCHASE, LEASE OR OBTAIN FINANCING FOR A VEHICLE. You should read this Agreement carefully. It contains the entire Agreement between You and Us. It takes precedence over any other written or oral statements made to You with respect to this Agreement. This is a service Agreement, not a warranty. Review "Special State Disclosures and Requirements" for any rights, privileges and conditions that govern this Agreement in Your state. Any modification(s), alteration(s) or change(s) to the preprinted terms and conditions is/are invalid and of no force or effect. If the Vehicle is ineligible for coverage, the Administrator will notify You within thirty (30) days of the Administrators receipt of the Agreement. You acknowledge Your understanding of and agree to the Dispute Resolution/Arbitration Agreement and Class Action Waiver section in this Agreement. Refer to the Dispute Resolution/Arbitration Agreement and Class Action Waiver section for opt- out instructions. This Agreement is based on information You provided in this Schedule Page. You acknowledge Your understanding of the limited applicability of the federal Magnuson Moss Warranty Act as set out in section G. of this Agreement. DO NOT SIGN BELOW UNTIL YOU HAVE READ THE ABOVE PARAGRAPHS. BY YOUR SIGNATURE YOU ACKNOWELDGE YOU HAVE READ THE ABOVE PARAGRAPHS UNDERSTAND AND AGREE WITH THESE DISCLOSURES. PAGE 1 CustomerSignature Dealership Signature Date ADMINISTRATOR: SMART AUTOCARE, P.O. Box 852770 Richardson, TX 75085 855-292-9309 AUTHORIZATION IS REQUIRED PRIOR TO THE COMMENCEMENT OF ALL REPAIRS! FOR NATIONWIDE CLAIMS CALL: 855-292-9309 SAC-WIN-VSC 08-2020 OEM Surcharge OEM Glass is that which is fabricated by the original equipment manufacturer to match the original windshield glass that was placed in the vehicle as of the contract sale date. This includes all front windshield cameras, sensors, and electrical components, that are part of the original vehicle’s front windshield. Term SAMPLE 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 320 340 360 380 400 420 440 460 480 500 520 540 560 580 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 320 340 360 380 400 420 440 460 480 500 520 540 560 580 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250 260 270 280 290 300 310 320 330 340 350 360 370 380 390 400 410 420 430 440 450 460 470 480 490 500 510 520 530 540 550 560 570 580 590 600 610 620 630 640 650 660 670 680 690 700 710 720 730 740 750 760 770 780 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250 260 270 280 290 300 310 320 330 340 350 360 370 380 390 400 410 420 430 440 450 460 470 480 490 500 510 520 530 540 550 560 570 580 590 600 610 620 630 640 650 660 670 680 690 700 710 720 730 740 750 760 770 780 CONTRACT_NUMBER_C CUSTOMER_NAME_CUSTOMER_NAME_CUSTOMER_NAME_C CUSTOMER_EMAIL_ADDRESS_CUSTOMER CUSTOMER_ADDRESS_1_CUSTOMER_ADDRESS_1_CUSTOM CUSTOMER_PHONE_CUSTOMER_PHONE_ CUSTOMER_CITY_CUSTOMER_CITY CUSTOMER_STATE CUSTOMER_POSTAL_CO DEALER_NAME_DEALER_NAME_DEALER_NAME_DEALER_NA DEALER_NUMBER_DEALER DEALER_ADDRESS_LINE_1_DEALER_ADDRESS_LINE_1_DEA DEALER_PHONE_NUMBER_DEALER_PH DEALER_CITY_DEALER_CITY_DEAL DEALER_STATE_DE DEALER_POSTAL_CODE LIENHOLDER_NAME_LIENHOLDER_NAME_LIENHOLDER_NAM LIENHOLDER_ADDRESS_LIENHOLDER_ADDRESS_LIENHOLD LIENHOLDER_PHONE_LIENHOLDER_PH LIENHOLDER_CITY_LIENHOLDER_CI LIENHOLDER_STAT LIENHOLDER_POSTAL_C 9999999 $9,999,999.99 5/2/2023 $9,999,999.99 9999999 VEHICLE_MAKE_VE VEHICLE_MODEL_V VIN_VIN_VIN_VIN_VIN_VIN_VIN_VIN_VIN 9999999 CUSTOMER_SIGNATURE_Y1_ DEALER_SIGNATURE_Y1_X1_ 05/02/2023 C D
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