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Is your system currently monitored? Yes No

Monitoring Provider: --Select-- Brinks ADT Protection One SecurityLink by Ameritech Other (fill out in comment box)

(Who do you pay your monthly monitoring bill to?)

Are you under contract to any other alarm service provider? Yes No

Equipment Type: --Select-- Visonic Linear SkyLink Caddx Ademco Radionics DSC ITI Other (fill out in comment box)

Equipment Make/Model: --Select-- PowerMax Ademco LYNXR Simon Vista Power 864 Other (fill out comment box)

(HINT: Look on your alarm panel where your main system is stored in your home or business.)

Do you own this equipment? Yes No

Is the system functioning now? Yes No

When was the system installed? --Select-- Less than 1 year Between 1-5 years Over 5 years

Is your system connected to a phone line? Yes No

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