Free Issue of Chrysler Profit & Protection Warranty Newsletter

For assistance with completing this form

> Call: 1.800.852.6298
> Email: customer service

If you would like to receive a FREE issue of Profit & Protection, please complete this form to receive your 2 free issues. Upon your last free issue you will receive a form to cancel your membership. If you do not cancel you will receive the remaining benefits including warranty manuals and quick reference help cards to complete the program. Your dealer account will conveniently be debited $40 each month for as long as you want the program! Yes, sign me up! I understand my dealer account will conveniently be billed $327 a month for as long as I want the program and I can cancel at any time.
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1. Contact information (name of individual who is to receive the program)
* First Name:	* Last Name:
Title:	Other:

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2. Company information:
* Company Name: Mailing Address: City:
State/Province: * Zip: Email:	* Phone: Phone Extension: Fax:
Shipping Address (if different from mailing): City:
State/Province:	Zip:

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3. Reason for interest in this product:

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* 4. Discounts: If you received a direct mail piece please provide the offer code to apply any applicable discounts.
OC# (Found near phone # or mailing label)
If you didn't receive a direct mail piece (postcard / letter / flyer), how did you know to seek J&L Warranty Pros for help?
	Other: