Siemer Preferred Customer Program Form This field is hidden when viewing the formCompany Email for Maintenance Plan Applications Administrative field: do not enter data hereThis field is hidden when viewing the formNo Reply Email Administrative field: do not enter data hereThis field is hidden when viewing the formCompany Name Administrative field: do not enter data herePlans* SPC 1 System Monthly Plan(1 Air Conditioner, 1 Furnace) $24/mo. fee SPC 2 Systems Monthly Plan(2 Air Conditioners, 2 Furnaces) $48/mo. fee SPC 3 Systems Monthly Plan(3 Air Conditioners, 3 Furnaces) $72/mo. fee SPC 4 Systems Monthly Plan(4 Air Conditioners, 4 Furnaces) $96/mo. fee Humidifier Monthly Plan(Includes The Humidifier Pad) $4 each/mo. fee Tanked Water Heather Monthly Plan(1 Tanked Water Heater) $8.25/mo. fee Tankless Water Heater Monthly Plan(1 Tankless Water Heater) $13.25/mo. fee Add On's Humidifier Monthly Plan(Includes The Humidifier Pad) $4/mo. fee Tanked Water Heather Monthly Plan(1 Tanked Water Heater) $8.25/mo. fee Tankless Water Heater Monthly Plan(1 Tankless Water Heater) $13.25/mo. fee Name* First Last Address* Street Address Address Line 2 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 Email* Phone*Referred by:I want to pay by* Check ACH This field is hidden when viewing the formTerms and Conditions I agree to the Terms and Conditions Agree to be Contacted* By submitting this form I am agreeing to be contacted by a representative of Siemer Heating, Cooling & Plumbing to confirm and sign up for an annual Maintenance Plan agreement. Consent If you have consented to receive text messages from Siemer Heating, Cooling & Plumbing, you may receive text messages about your appointment details (appointment reminders, account notifications, etc.) Message and data rates may apply. Message frequency varies. You can opt-out at any time by replying STOP. For help, reply HELP or review our privacy policy. Reply STOP to opt-out from Siemer Heating, Cooling & Plumbing. Opt-in data and information obtained as part of SMS consent will not be shared with third parties or affiliates. No further messages will be sent after opting out. Need HVAC Service? Contact the experts at Siemer Heating, Cooling & Plumbing. Call us at 219-923-9234! REQUEST SERVICE