PIF EQUIPMENT PURCHASE FORM

Equipment Purchase Order Acknowledgement Form
Customer's Full Name*
Complete Address where system is located (include city/state/zip code)*
Customer's E-mail address*
example@example.com
ADT CS Account #*
ADT CUSTOMER NAME If different (type "NA" if the same)*
PURCHASE ORDER
List all items purchased by customer per line (quantity, then item name)*
Type a question*
Last 4 digits of card
Total Cost*
Customers Signature*

Clear
Date*

MonthDayYear
Date
I signed this form on the date listed herein and consented to electronic signature method. A copy was emailed to me. Upon purchase, I will own these devices listed above. Purchase includes professional installation, extended warranty, monitoring of alarm devices (when ADT monitoring agreement is active), and google video access/storage (when video devices are purchased All sales are final once devices have been installed in the home/business. A return trip may be required to fulfill requested items by customer and such delay is no fault of company. A 15% restocking fee applies for all devices once order has been made.
THANK YOU FOR YOUR YOUR BUSINESS
3604 Fernandina Rd., Ste. 207-B, Columbia, SC 29210
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