Prospective Security Buyer Form

Complete This Simple Home Security Questionnaire.
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Re-type E-mail*
Your E-mail and Re-typed email must match to submit this form!

(the submit button will remain hidden unless the emails match)
What would you like help with today?*

Request Recommendation for Existing SystemUpgrade Existing Home SecurityNew Construction
What would you like in your new Home Security system?*

ControllerSmart Door LocksDoor/Window SensorsMotion SensorsSecurity CamerasGas/Water DetectorsSirens
# of Smart Door Locks*
# of Door/Window Sensors*
# of Motion Sensors*
# of Security Cameras*
# of Gas/Water Detectors*
# of Sirens*
What features would you like to add (optional)?*

Music (AM/FM Radio)Music (Bluetooth)Video with local controlVideo with remote Smartphone controlOther
Who is the manufacturer of your current system?*
How many wires does your current system have?*
If the amount of wires is unknown, please attach a photo of your currently installed system.

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What components does your current Home Security System include (check all that apply)?*

ControllerSmart Door LocksDoor/Window SensorsMotion SensorsSecurity CamerasGas/Water DetectorsSirens
# of Smart Door Locks*
# of Door/Window Sensors*
# of Motion Sensors*
# of Security Cameras*
# of Gas/Water Detectors*
# of Sirens*
Address (For Quotation of Shipping Charges Only)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Comments
By providing my phone number to “Home Controls Inc.”, I agree and acknowledge that “Home Controls Inc.” may send text messages to my wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to Opt-out by replying “STOP”. For more information on how your data will be handled please visit https://www.homecontrols.com/privacy-policy.*

I agree and acknowledge.
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Complete This Simple Home Security Questionnaire.