|
Business Name: _�C : -/ /& C. Uns L- ( 7 ; L Owner/Manager Name: /3L171/14? ,✓
<br /> Street: 5 3 4/-/ ,S _
<br /> ��' _..__ ___.,.......__. Installation Phone # ( / 3 _) - Y - � / /
<br /> City: .- ' 7 ythi i // S Home Phone # (_ J - -
<br /> County: f'
<br /> ty >� u eS ( C..) Stat�><- :........ Zip: ,3 3 :S - V .2•-- Cellular Phone # ��. "Z` ) • 4 /� % - �' - 74:)_.d.--
<br /> Cross - Street: � /Z 00 4 `f _ .._.._._._.._..........._....__ Email:
<br /> Date Scheduled: ❑ AM ❑ PM SYSTEM TYPE: 1 l S ! Gt jx✓' C f
<br /> ❑ New Installation ❑ Conversion ❑ Takeover `Add ❑ CSR Add
<br /> ❑ Move/STO ❑ Move (Previous Address)
<br /> Building Style: ❑ Split -Level ❑ Multi -Story (Single Story Square Feet. -' g�U
<br /> Basement: [] Finished ❑ Siab ❑ Unfinished Ceiling Height: 1
<br /> Attic/Ceiling: C! Open ❑ Vaulted/Drop "15f Crawl Space
<br /> Flooring: ❑ Tile/Hardwood ❑ No Carpet (Partial Carpet ❑ Full Carpet
<br /> Comments:
<br /> Brink's Home Security' is providing the Equipment to you subject to the terms and conditions of your Fire System Service Agreement including Sections 6 through 8. You
<br /> acknowledge that Brink's' has explained the full range of Brink'sa equipment available and you have selected the equipment listed below.
<br /> QTY EQUIPMENT PRICE' Discount) TOTAL*
<br /> e f' < - 1 u HIS ST 0 c.i. J I QC- r 7'L-' I 9 c'cf
<br /> I c c) !n c t o C,> (A.) r re -1: ,S ci .,s-7-0 -t-i- S6 , ' (° 53 , I L
<br /> 1 F /r'i S >'. - .. - -- $9, ' G g , 3G 1'
<br /> 1 i -n t T G C. - la 1 0 r _ , , , C1 U k 1 -rnt u .- S ME- .-1° , -..
<br /> I A - - = ' ' 6 C:' . ' :I drireS'a.1,�1e iOJ iF, b .).1b , to
<br /> 1 ' I_.�KV . . tr e. 6 5(i - 4 -.. , - ,- . &? K e y pc, ti -- lo n e. o " cc
<br /> Ex c IA( t cAi•P <ax '; j°'1 -‘‘.,C, p c& 11 Si t".7 - f V 1
<br /> "Pricing and location quoted by a sales representative subject to approval of Brink's' technician. ( wWaae)
<br /> `Additional $500 fee required to purchase Protective Equipment. POLICE/FIRE PERMIT /So 00
<br /> Of appal w.)
<br /> ADMIN FEE
<br /> (where allowed) j,S ,, ! 6
<br /> Technician Comments: ,
<br /> 1 SUBTOTAL'
<br /> 2. ADJUSTMENT
<br /> — -
<br /> 3. TOTAL ',la.§ y ¢ i? '" (.
<br /> Date /me Started _ / . / _ : -- _....._....... 4. TAX /O, 3s ,/-t - , `
<br /> DatefTime Completed —, - „_- r _ _ I _ 5. MONITORING
<br /> ....................... (inqudina Taxl ---
<br /> 6. SERVICE PLAN
<br /> Date /Time Monitored - -_ — / / ._
<br /> Tech(sl ___ . 7. {TRd g Tax) IVITY
<br /> 8. TOTAL /6/6, L/$76///, 06 4
<br /> VRT Verify#.....,. (Lnre3 a
<br /> 9. LESS PREPAY g020 r
<br /> Dps Rep. .....
<br /> 10. BALANCE DUE` 7eli (;*. 9' 1
<br /> Number and Location of Fire Alarm Devices
<br /> Brink's will consult your local fire department or other organization, office, or individual responsible for approving equipment, materials, an installation, or a procedure relat-
<br /> ed to fire protection in your location ( "AHJ ") to attain approval regarding required fire protection in your location. You understand that the type, quantity and location of
<br /> the Equipment identified above are subject to approval and revision by the AHJ. You understand and agree that if the AHJ determines that any modifications
<br /> or additional Equipment are necessary, you will pay Brink's additional charges for any resulting modification and/or additional Equipment.
<br /> You accept t the Brink's' Protective Equipment and ackr 3wledge its placement, installation, demonstration and testing to your satisfaction.
<br /> PLEASE CHECK WITH POLICE AND LOCAL GOVERNMENT ON PERMIT REQUIREMENTS,
<br /> acknowledge that you h, a ;, ad and understand the information above regarding selection of fire alarm devices. You also acknowledge that yoti
<br /> s n; o nsihle "or In. =,;far as eitated aixase. ,,
<br />
|