Client Monitoring Data Form
Required fields are marked with an asterisk (*)

Client Information
Client Name: *
Day Phone: *
Night Phone: *
Fax: *

Site Address
Address: *
City: *
Province: *
Postal Code: *

Emergency Notification List

(People called and in what order in event or alarm)
NAME (Full Name Please) Home Phone Work Phone
1.
2.
3.
4.
5.

Identification Card Authorization List

(Full Name)
1. 2.
3. 4.
5. 6.
7. 8.
9. 10.
11. 12.
13. 14.

Check which service is required
REQUEST GUARD DISPATCH $55.00 PER CALL.
METRO TORONTO POLICE. USER FEE PER FALSE ALARM $105.00, SUSPENDED AFTER 3 CALLS, 365 DAYS
REQUEST CALL NOTIFICATION LIST. ONLY WHERE APPLICABLE (NOT FOR FIRE, OR PANIC, OR HOLDUP.)

Terms
IMPORTANT: PAYMENT IN FULL AND THIS SIGNED ACCEPTANCE FORM MUST BE RECEIVED BEFORE MONITORING CAN BE ACTIVATED, PAYMENT MUST BE RECEIVED. CLIENT IS RESPONSIBLE TO IMMEDIATELY PAY FOR ALL GUARD, POLICE, FIRE CALLS OR ANY OTHER USER FEE IMPOSED BY RESPONSE PROVIDERS. PAYMENT NOT RECEIVED WITHIN 30 DAYS WILL RESULT IN SUSPENSION OR TERMINATION OF ALL SERVICES, WITH NO LIABILITY TO OMNI SECURITY LTD. OR ITS CONTRACTORS WITHOUT NOTICE, AND THE IMMEDIATE PAYMENT OF THE 3 YEAR MONITORING CONTRACT OR BALANCE REMAINING. IN ADDITION A REACTIVATION FEE IS IMPOSED FOR REINSTATEMENT OF THE SERVICE, THE SYSTEM WILL BE REMOVED WITHOUT NOTICE OR LIABILITY TO OMNI SECURITY LTD. OR ITS CONTRACTOR FOR LOSS OF SERVICE OR PROTECTION OR DAMAGE TO THE SITE. OR ANY OTHER SERVICE STATED OR IMPLIED. CONTRACT AUTOMATICALLY RENEWS TO ANNUAL BASIS UNLESS WRITTEN NOTICE IS RECEIVED BY OMNI SECURITY LTD. 60 DAYS PRIOR TO ANNIVERSARY.

I ACCEPT THE ABOVE NOTED PROPOSAL, AND ACKNOWLEDGE THAT I HAVE READ AND THAT I UNDERSTAND THE TERMS AND CONDITIONS CONTAINED WITHIN, AND THAT BY SIGNING HEREUNDER BECOMES A BINDING CONTRACT.

Acknowledgement
Client's Authorized
Representative:		 *
Address: *

Copyright (c) 2008 Omni Security Ltd. All Rights Reserved.