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Customer Contact List
Customer contact form to establish their emergency contact list and instructions.
Your Information
Contact information for the person submitting the form
Name
*
Your full name
Email
Your email address
Phone Number:
*
Your phone number
Client Service Representative
*
Select Your Client Services Representative
Kevin Allison
Chad Asselstine
John Base
Sandra Bradshaw
Natalie Busshoff
Kevin Jarrett
Ron Landry
Joe McCann
Steve Pike
Khurrum Qureshi
Paul Shatford
Larry Thibedeau
I don’t know
Please select your Client Service Representative from the drop down menu.
Street Address
*
Building’s street address
City/Town
*
City or town where the building is located
Postal Code
*
Postal code of the building
Building Name
Name of building (if applicable)
Phone Number at Building
*
What is the main phone number of the building?
Customer Call List
Minimum 3 contacts are required
Last Name
First Name
Phone #
Phone Type (Home, cell, etc)
System Password
Special Instructions
Please include any special call instructions regarding calling times and days. For example, Only call Joe Smith M-F from 7 p.m. – 5 a.m.
Do you have specific call patterns (who is called first to last) dependent on the type of alarm that is activated, which would differ from the standard call list provided above?
*
Yes
No
Name Incident Type For Call Pattern 1
(ie. fire alarm, intrusion alarm, temperature alarm, etc.)
Call Pattern 1
*
Name
Phone Number 1
Phone Number 2 (if applicable)
Name Incident Type For Call Pattern 2
(ie. fire alarm, intrusion alarm, temperature alarm, etc.)
Call Pattern 2
Name
Phone Number 1
Phone Number 2
Check box below if pattern is the same as Call Pattern 1
Repeat Action Pattern 1
Special Call Pattern
Incident Type
Name
Phone Number
Specify when this action pattern becomes applicable
Name
This field is for validation purposes and should be left unchanged.
Are you ready to submit the list of users who will have unique codes for your alarm system?
*
Yes
No
Please enter your Usernames and Codes.
Username
Code