Service Finance Customer Acknowledgement

CUSTOMER INFORMATION
Name of person doing the consumer financing*
Address where alarm system is located*
E-Mail address for the person doing the consumer financing*
example@example.com
ADT CS Account Number*
ADT Account Customer Name (if is the same name above, type "SAME")*
Thank you for becoming a valued customer and trusting us to help you protect what matters most to you. In an effort to maintain clarity, this acknowledgement form is provided so that you have a clear understanding of your monthly payments.

I understand that I am utilizing my Service Finance Company's account to purchase additional equipment through Carolina Smart Home in connection with my ADT monitoring service. The following payment breakdown applies:
Service Finance's Monthly Payments*
Service Finance's Term*
ADT Monthly Payment (separate from Service Finance's payment)*
I understand that my enhanced equipment purchase is separate from the ADT monitoring services. The ADT monthly monitoring services will show in my bank/credit card statement as "ADT Services". My ADT monthly monitoring service is $
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.
THANK YOU FOR YOUR YOUR BUSINESS
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