Member Enrollment Customer InformationName* First Last Address for the Property Being Covered* Street Address City State / Province / Region ZIP / Postal Code Home Phone Cell Phone* Email Address* How Did You Hear About Us?* WelGard Membership LevelsWelGard Protection Monthly Payment - $45.00 Annual Payment- $499.00 Includes all Benefits of Support Level, plus - WelGard’s immediate response guarantee (or the hotel is FREE!) 24/7/365. - Highest quality repairs guaran-teed; based on experts. - Drilling of up to 10 new wells included (2,970 feet). - TOTAL PROTECTION –ANY-THING that fails in the well system-NO COST TO YOU. - Bi Annual Inspections/Testing. - Discounts-water treatment - Keep your system in “WelGard® Shape - No worries – Peace of MindWelGard Support Monthly Payment - $19.00 Annual Payment - $199.00 Includes all Benefits of Info Community Level, plus – WelGard’s immediate response guarantee (or the hotel is FREE!) M-F; excl holidays. Vetted, experienced team. WelGard® coordinates repairs. Lowest cost repairs guaranteed – decision based on experts. Portion of membership cost applied toward inspection services.WelGard Information Prepaid - $5.00 One time fee Online information; expert answers to your well system questions. Expert learning – periodic emails. You select the topics. Interactive forum and discussions. Ongoing dialog.Best Time to call me Hours : Minutes AM PM AM/PM Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Billing AddressIf different from property address. Street Address Address Line 2 City State 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 ZIP Code Terms & ConditionsTerms and Conditons* I agree to the terms and conditions CommentsThis field is for validation purposes and should be left unchanged. Δ
