Order Form

WIDE-WORLD-ONE MONITORING INFORMATION FORM

We will program your system prior to delivery upon your request

Please provide the following contact information in red:

(check one)

SUBSCRIBER: Business Residential

RECEIVER FL Account #

Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

FAX

E-mail

URL

You need to specify a pass-code for the monitoring company operators. In the event of an alarm, the operator will ask for this pass-code, via the alarm system. If the person present is unable to provide it, the operator will call the police. The pass-code is simply a word, up to six characters. It can be changed at any time by calling WIDE-WORLD-ONE at 1-888-656-1611 the monitoring company.
Pass-code:

Again, you can change these codes at any time.

You can specify up to 5 persons to be called in the event of an alarm: Other than the proper authorities

Our Operators notify all the proper authorities. We do not call 911.

Name (Please fill out form) Phone 1 Phone 2

Please list the phone number in red for the proper authority for your area.

ZONE PROTECTED AREA AUTHORITY PHONE NUMBER

1 FIRE DEPARTMENT

2 MEDICAL PARAMEDICS

3

4 PER/TAMPER/24 HR POLICE

5 INTERIOR POLICE

6 PANIC-POLICE POLICE

7 AMBUSH S/D POLICE

8 TROUBLE-LOW BATTERY (SERVICE ALARM CO)

9 RESTORE

FOR BUSINESS ONLY: OFFICE USE ONLY

HOURS MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

Open

Close

Holiday

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Monitoring Information Form (1) (please print out this present form for your records)
Please print out the below form sign same, FAX to (949) 489-1611 or Mail to the below address. We need this information before delivery, so please return this form as soon as possible. Thank you

AGREEMENT MONITORING FORM (2) Click here

MONITORING SERVICE MONTHLY PAYMENT @ $33.00.

Credit Card Information (if Payment Method is Credit Card) Place a "check" in one of the Boxes below of the credit card of your choice.
Accepted Cards	Visa
	MasterCard
	Amex
Card Holder's Name
Card Number
Exp. Date	(mmyy)

1. The customer understands that the Company is in the business of providing telephonic monitoring services for customers who have electro-protective systems at their places of business, homes, etc. The customer understands that the Company must know and have on record basic information about the customer's system. The customer also acknowledges that he has completed the portion of this contract which calls for that information, and the Company, in performing its obligations under this contract, will rely on the information given by the customer.

2. Subscriber hereby represents that it has contracted, or is about to contract, with installer for the installation of a protective system at premises owned or occupied by subscriber and in connection with such installation has also requested monitoring service of said system. Installer and Subscriber have entered into an agreement whereby the Installer will provide monitoring services for the Subscriber consisting of the following: (Free pre-package offer only) The Subscriber also understands and agrees, that the Free pre-packaged unit is only available to them only with this monitoring service. If the Subscriber does not have said system installed within 30 days of receipt of same, any money balance due the Company will be paid in full upon demand. Subscriber also understands that if any payments to the Company is more than 10 days late, payment in full will be paid by this Subscriber in full. Subscriber understands that this is a None-cancelable agreement, after payment the Free Pre-packaged unit will become his sole property.

SUBSCRIBER’S SIGNATURE : X-------------------------------------------------DATE-----------------------2002

WIDE-WORLD-ONE

31992 Via La Plata

SJC, Ca., 92675

For more information Call Toll Free 1- 888-656-1611

E-Mail WIDE-WORLD-ONE@earthlink.net