Residential Program

ADT Monitored Security System Request Form

Residential Program

Customer First Name:

Customer Last Name:

Customer Street Address:

City:

State: Zip:

Home Phone:

Work Phone:

Alert Security Package

Master Control Panel	3 Door Contacts
Interior Motion Sensor	Interior Siren
Backup Battery	Transformer
Digital Communicator	RJ-31X Telephone Jack

Get a "Free* Home Security System Monitored by ADT" anywhere in the USA. Now home security systems are more affordable to suit your budget.

*System includes: 1 control panel, 1 touch pad, 3 hardwired door contacts, 1 motion detector, 1 indoor siren, 1 Telco jack and 1 yard sign. $99.00 Customer Installation Charge. 36-month monitoring agreement required at $33.99 per month ($1,223.64). Form of payment must be by credit card or electronic charge to your checking or savings account. Offer applies to homeowners only. Local permit fees may be required. Satisfactory credit history required. Certain restrictions may apply. Offer valid for new ADT Authorized Dealer customers only. Other rate plans available. Cannot be combined with any other offer.

By choosing ADT monitoring your customer will get the very best services and industry leading guarantees.

1. THEFT PROTECTION GUARANTEE: If your home is burglarized while protected by ADT, the company will pay you up to $500 toward your insurance deductible, if you meet the required criteria.

2. "SYSTEM FOR LIFE" GUARANTEE: If you move after two years, ADT will install a basic system in your new home FREE of charge.

3. OUR HOMEOWNERS INSURANCE GUARANTEE: You may be eligible for a discount of up to 20% off the annual cost of your homeowners insurance with your ADT system.