Request for information on a new system with ERT Security
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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
I'd like a evaluation of both so I can take advantage of your discounts
Protection Level Survey
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Please select what types of life safety protection that you are interested in
Intrusion protection
Intrusion with monitored fire protection
Open/Close reporting of my employees
Cellular Backup Communications
Panic/Holdup/Medical
Sump Pump Monitor
Furnace Monitor
Carbon Monoxide Monitoring
Wireless remote control of system
Medical Alert System Only
CCTV Camera System
CCTV Camera System with remote viewing
Refrigeration Monitoring
Gate Monitors
Other
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About the property that the system would be installed do you
Own the property
Rent the property
Lease the property
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How soon do you want or need the system?
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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 exterior doors leading outside or into a garage are there?
1
2
3
4
5 or more
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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Installation Access
Complete unfinished basement
Partially finished basement
Crawlspace
Slab
Full attic
Limited attic
Drop ceiling
How much have you budgeted for your new system?
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