Request for information to switch to ERT Security from another provider
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Last Name
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First Name
Company
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Address
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City
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State
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Zip Code
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Phone
Mobile Phone
Fax
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Email
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How did you hear about us?
ERT Security Web Site
We phoned you
Referral from a current client
Recieved a mailing
Search engine results
Linked In
Craig's List
Newspaper
Radio Advertisement
Other
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Is the system in a home or business?
Home
Business
Current Protection
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Do you currently have an alarm system installed?
Yes, and it is monitored
Yes, but is not monitored by anyone
Yes, but I just moved in
No, but I'd like one installed
Other
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Please select what types of life safety protection you already have
Alarm System intrusion protection with no wireless devices
Alarm System intrusion protection with wireless devices
Alarm System with monitored fire protection
Alarm System with Open/Close Reporting
Cellular Backup Alarm Communicator
Panic/Hold up Alarm
Sump Pump Monitor
Furnace Monitor
Carbon Monoxide Monitor
Wireless remote control of the system
Medical Alert Pendent
Medical Alert System Only
CCTV- Camera System
Other
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Current Provider
What do you currently pay monthly for basic alarm monitoring if over $10.00 per month?
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Do you own the system?
Yes
No
I don't know
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How soon do you want or need to switch?
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What type of system do you already have? Please include as much information as possible to describe the manufacturer, model or type of alarm panel and/or keypads.
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Do you currently have DSL telephone service or a telephone service that runs through a internet router?
Yes
No
Not Sure
No telephone line is currently installed
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How many keypads are currently installed?
1
2
3 or more
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Do you have pets? If so please provide us with how many, types and the weight of each and if they have free roam when everyone is away.
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