Radio Backup Request FormPlease fill your information below. PDF Download Please Choose a Radio Type VSecurity System RadioVFire Alarm or UL Security System RadioAccount Information Customer Name * (Company or Individual Name)Contact Person *Account #Phone *Email Adress * Enter EmailConfirm EmailProject Address * Street AddressCityIllinoisv AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP CodeVOption 1: Radio Installation- Purchased RadioBy signing this form, I warrant that the information submitted herein is true and correct. I agree to the Radio installation price of $575+Labor* (Security System) or $875+Labor* (Fire Alarm or UL Security System) * Usually about 2 hours. Labor cost is $100/hour for residential customers and $125/hour for commercial customers. Pricing is subject to change without notice.VOption 2: Radio Installation- Leased RadioBy signing this form, I warrant that the information submitted herein is true and correct. I understand that there will be no installation fee, but this lease requires a 5-year contract at $85/month.Name * First Name *Last Name *Date *´Signature *Please Sign here using your mouse.For tablet user please sign with your finger.? Clear Submit
