SecurityLine Basic Order Form

Please take a moment to fill out the following form and you will be contacted by a SecurityLine sales associate.

This form is only to gather information for us to help configure a SecurityLine setup for you to best serve your security needs. This form does not commit to any contracts, nor will it register for SecurityLine service. This information will be kept confidential and is available only to SecurityLine sales staff.

Surname:

Given Names:

Address:

City:

Province/State:

Country:

Phone #1:

Phone #2:

Email:

System Options:

HARDWARE:		Quantity:

SecurityLine Video Camera	$ 425 each
SecurityLine Wireless Video Camera	$ 500 each


Optional Add-ons:
SecurityLine DVR (Digital Video Recorder)	$ 1,500

OPTIONAL INSTALLATION SERVICES
SecurityLine Basic System Installation	Request Quote

System Information

You are currently requesting information for the SecurityLine Basic system.

Do you currently have an alarm panel installed?

Yes No I don't know *

If you currently have a computer network router, which brand is it?

*
^{or other:}

If so, is your router wireless-compatible?

Yes No I don't know

Comments

Please let us know if you have any additional questions, or special comments and/or requests for your system:

Survey

How did you hear about SecurityLine? *