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Location Information
Account #:     Found on the invoice mailed to you.
First Name:   Last Name:   
Address:  
City:   State:     Zip:   
Premise Phone:  
Email Address:    
Payment Option 1: (Checking Auto-Draft)
Bank Name:
Name on Bank account:
Checking Account #:
ABA Check Routing Number:
Check sample
Payment Option 2: (Credit Card or Debit Card Auto-Draft)
Name on Credit Card:
Address for card:
City, State & Zip for card: State:   Zip: 
Credit card number:
3 digit verification number:
Expiration date (month/year):  
Credit Cards
Payment Option 3: (Have Certified Security Systems call me)
Although the information collected in this online form is kept secure/encrypted via SSL some people are not comfortable with using such a system. We can get around that by having one of our customer service representatives give you a call and ask for the billing information over the telephone. The rest of the form (non financial information) still needs to be completed to make the activation process quick and error free.
Phone number to call
(premise number used if left blank):
Amount & Frequency
Amount:   The monthly amount due shows on your
latest mailed invoice.
Frequency:
Authorization
I authorize the above transaction (full name):  
Date of authorization: