Customer Service Agreement - ADACS Security Systems

Customer Details

Company/Customer Name*

Customer Number*

Customer Email*

ABN

Trading Name

Billing Address*

Suburb*

State*

Postcode*

Site Details

Monitored Site Address*

Contact Name*

Email*

Site Phone 1

Site Fax

Site Voice Code

After Hours Alarm Contacts (Minimum of Two Contacts Required)

Name*

Phone*

Voice Code*

Name*

Phone*

Voice Code*

Name

Phone

Voice Code

It is the responsibility of the client to ensure that after hours contacts are aware they may be contacted at any time in the event of an alarm activation or emergency situation. It is also the responsibility of the client to advise ADACS in writing of any changes too after hours contact numbers.

Billing Details

SERVICES

Term of Contract months

Standard Alarm Monitoring per month

Self Monitoring per month

Video Monitoring per month

Maintenance Plan per month

Other per month

Total excluding GST per week

PAYMENT DETAIL

Payment Option

Credit CardDirect Debit

Card Type*

Card No.*

Expiration Date*

CVC*

Card Holders Name*

Card Holders Signature*

Acceptance

Authorized Customer Signatory*

Position

Full Name

Date

( * ) Required Fields