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Vehicle Service Contracts

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					                Motor Vehicle Service Contract
                    (For Filings Required by Iowa Motor Vehicle Service Contract Act
A "Provider" is a person/business that sells or offers to sell service contracts. Providers are distinguished from
"Service Companies" in that Service Companies issue and are obligated to pay on claims made under the service
contract. Iowa Code Chapter 516E requires each provider to complete and file this form and filing fee not later that
August 1st of each year.

 Legal Name of Provider:

 d/b/a


 Mailing Address:

 City:

 State:

 Zip Code:

 Location of Iowa Books & Records:

 Address :

 City :

 State:

 Zip Code:

 Federal Employer Identification #:


 Motor Vehicle Dealer License #:

 Contact Person For Filing Issues

 Address:

 City:

 State:

 Zip Code:

 Telephone Number:
 Fax Number:

 Email:


 Contact Person For Service Complaint

 Address:

 City:

 State:

 Zip Code:

 Telephone Number:

 Fax Number:

 Email:

Please Note: The SBS Connect System will provide you with the area to lis all of the
"SERVICE COMPANIES" whose Motor Vehicle Service Contracts you are selling.
le Service Contract "Provider"Annual Filing Form
quired by Iowa Motor Vehicle Service Contract Act - Chapter 516E
ss that sells or offers to sell service contracts. Providers are distinguished from
vice Companies issue and are obligated to pay on claims made under the service
6E requires each provider to complete and file this form and filing fee not later that
ystem will provide you with the area to lis all of the
Motor Vehicle Service Contracts you are selling.

				
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