Buyer’s Signature Date
Buyer’s Name
PIZetatSytiC
999 E. Touhy Ave., Suite 500, Des Plaines, IL
TEL: (773) 777-0707 | TOLL FREE: (800) 877-3624
FAX: (773) 286-1992 | www.emergency24.com
1 fo 1 egaP9102/30 noitallecnaC fo ecitoN tnemeergA ecivreS gnirotinoM
EM24
Monitoring Service Agreement
NOTICE OF CANCELLATION
Address
YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE (3) BUSINESS DAYS
FROM THE ABOVE DATE.
If you cancel, any payments made by you under the contract WILL BE RETURNED WITHIN TEN (10) BUSINESS
DAYS following the receipt by the company of your cancelation notice.
To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other
written notice to:
EMERgency24, Inc.
999 E. Touhy Ave., Suite 500, Des Plaines, IL 60018
NO LATER THAN MIDNIGHT OF_____________________________________________________________________________ __
(enter original transaction date above)
116548 EMERGENCY 24 MONITORING SERVICE AGREEMENT PROOF (LOW RES).pdf 1 4/23/19 9:22 AM
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signature
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ACCT # ________________
STRESS CODE ______________
TIME ZONE: ECMPAH
P E Y Q
CHECK HERE FOR DATA VALIDATION PKG
LAITNEDISERLAICREMMOC:EMAN REBIRCSBUS
# RLF/.GDLB/.ETS/.TPA:SSERDDA
LOCATION/DIRECTIONS:
:EDOC PIZ:ETATS:YTIC
SUB. PRIMARY PHONE #: SUB. SECONDARY PHONE#:
SUB. CELL PHONE #: SUB. EMAIL:
:ETAD TRATS ROTINOM :# ENOHP RELAED:# RELAED
:# TIMREP YTIC/ECILOP:TNEMPIUQE
AUTOMATIC TEST CIRCLE ONE
WEEKLY
DAILY
MONTHLY
( __________________ )
( __________________ )
( __________________ )
( __________________ )
SUBSCRIBER DATA SHEET
( __________________ )
( __________________ )
( __________________ )
( __________________ )
PASSCODES/PASSWORDS (3-10 CHARACTERS)
999 E. Touhy Ave., Suite 500, Des Plaines, IL TEL: (773) 777-0707 TOLL FREE: (800) 877-3624
FAX: (773) 286-1992 — www.emergency24.com DEChanges@emergency24.com
YFITONTXETENOHPLLECENOHPYRADNOCESENOHPYRAMIRPEMANYTRAP
1
2
3
4
5
6
7
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( ) -
2ND PHONE
2ND PHONE
2ND PHONE
2ND PHONE
COMMERCIAL ACCOUNTS VERIFY ALARM SIGNALS DURING BUSINESS HOURS ONLY
Sample
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
(09:00)-OPEN
(18:30)-CLOSE
VERIFY ALARM SIGNAL ON THESE CONDITIONS:
( _ _ : _ _ )
( _ _ : _ _ )
( _ _ : _ _ )
( _ _ : _ _ )( _ _ : _ _ )
( _ _ : _ _ )
( _ _ : _ _ )
( _ _ : _ _ )( _ _ : _ _ )
( _ _ : _ _ )
( _ _ : _ _ )
( _ _ : _ _ )
( _ _ : _ _ )
( _ _ : _ _ )
( _ _ ) ( _ _ ) ( _ _ ) ( _ _ ) ( _ _ ) ( _ _ ) ( _ _ ) ( _ _ )
** ENTER ALL CONDITION TRANSMISSION POSSIBILITIES: (CODE RANGES ARE ALLOWED I.E. 3 TO 8 = BURG)
CODE TRANSMITTED
TO
EMERGENCY 24
DESCRIPTION/TYPE OF ALARM SIGNAL
CALLBACK
OPTION
REQUIRED FOR ACTIVATION AUTHORITY DISPATCH NUMBERS
CALL LIST: PARTIES WILL BE CALLED IN SEQUENCE UNTIL REACHING ____ OF THEM.
ADDITIONAL ENTRIES CAN BE MADE ON ADDENDUM FORMS AVAILABLE FROM THE DATA ENTRY DEPARTMENT.
(
REQUIRED FOR ACTIVATION)
FORMAT:
3+1/4+2
Radionics/Modem II/III/IV/ BSFK
DMP
Contact ID
S.I.A.
0 = A-P-C
1 = S-A-P-C
2 = P-C
3 = C
4 = L
5 = S-C
6 = S-P
8 = P
9 = S.NA;PNA;C
10 = S,NA;C
11 = A
12 = C TP
13 = P TP
14 = S,NA;P
15 = S-P-C
16 = A-S-P-C
17 = SNA; PTP, A
18 = S,P,C
19 = PTP, A
17 AND 19 ARE
NOT ALLOWED
FOR
FIRE OR MEDICAL
ALARMS
S = CUSTOMER L = LOG ONLY
A
= AUTHORITY NA = NO ANSWER
P
= PARTY TP = TOP PRIORITY
C
= INSTALLATION COMPANY
CALLBACK OPTIONS
(CHOOSE ONE FOR EACH CODE)
( ) -
POLICE DISPATCH #:
FIRE DISPATCH #:
MEDICAL DISPATCH #:
OTHER DISPATCH #:
( ) -
( ) -
( ) -
( ) -
THIS AGREEMENT IS SUBJECT TO THE TERMS AND CONDITIONS
SET FORTH IN THE MONITORING SERVICE AGREEMENT.
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( ) -
( ) -
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( ) -
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116548 EMERGENCY 24 MONITORING SERVICE AGREEMENT PROOF (LOW RES).pdf 2 4/23/19 9:22 AM
116548 EMERGENCY 24 MONITORING SERVICE AGREEMENT PROOF (LOW RES).pdf 3 4/23/19 9:22 AM
116548 EMERGENCY 24 MONITORING SERVICE AGREEMENT PROOF (LOW RES).pdf 4 4/23/19 9:22 AM
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signature
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click to sign
signature
click to edit
click to sign
signature
click to edit
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