LSA Referral Form

Tell your friends, family, co-workers & neighbors about LASWELL SECURITY & AUTOMATION

Earn a $200 VISA Gift Card for each new customer you refer through this form that signs up for monitored home or business security.

Ready to refer a friend or family member? Here's how it works.

1. Submit a referral through our Referral Rewards program using this form.

2. When your friend activates and installs a new LSA account, we will provide you a $200.00 credit towards your monthly monitoring. If you are not a current customer, no problem, we will send you a $200.00 VISA Gift Card!

3. Refer as many people as you like! We will apply additional credits to future months or keep sending you gift cards!

YOUR NAME*

First NameLast Name

YOUR EMAIL

example@example.com

YOUR PHONE NUMBER

Area CodePhone Number

YOUR REFERRAL*

First NameLast Name

THEIR EMAIL

example@example.com

THEIR PHONE NUMBER

Area CodePhone Number

A referrer may or may not be a current Laswell Security & Automation. Once the new customer’s contract has been received, the $200 Visa Gift Card reward will be issued to the referring party. The referring party may not be a member of the same household as the referee.

Please verify that you are human*