ADT INSURANCE CERTIFICATE

Date

Customer's Name*

Monitoring Address*

E-Mail Address*

example@example.com

Customer's Contact*

This is to certify that Carolina Smart Home, ADT Authorized Dealer has installed an ADT monitoring security system for the above mentioned customer.

The following services are being provided

ENHANCED MAINTENANCE AGREEMENT

*This system uses cellular radio as primary source of communication with ADT central station

Insurance Company*

Insurance Agency Name*

Insurance Policy*

Date System has been active since*

Please note that the monitoring services selected above are standard ADT services and may not reflect additional monitoring features selected that do not require reporting for standard monitoring service. Fire monitoring option only applies to residential customers. If you have any questions, please contact us @ 1-800-750-3718, Ext. 2