4G Monitoring from $9.90 Week 4G New Connection* Indicates Required FieldsCommentsThis field is for validation purposes and should be left unchanged.CONNECTION PLAN4G WIRELESS CONNECTION PLAN*I select the following Minimum commitment period. A. NO CHARGE Connection with 36 Month commitment OR Existing MSE 4G Connection B. $199 + GST Connection Fee with 24 Month commitment C. $299 + GST Connection Fee with 12 Month commitment D. $399 + GST Connection Fee with No Lock In Period4G MONITORING SERVICE LEVEL* 1. NON MONITORED Self Notification Only $6.80 + GST Wk 2. PREMIUM Class 2 (1 x SIM) + Mobile Notify App = $9.90 + GST Wk 3. PREMIUM Class 2+ (2 x SIM) + Mobile Notify App = $13.90 + GST Wk 4. HIGH SECURITY Class 3 (2 x SIM) + Mobile Notify App = $17.90 + GST WkRecurring Invoicing Period? 3 Monthly 6 Monthly 12 Monthly4G MOBILE APP*1. ENABLE MOBILE APP - included with PREMIUM MONITORING2. NO MOBILE APP REQUIRED4G MOBILE APP - Administrators Name*NOTE: Administrator has the authority to add, edit or remove all other App users.4G MOBILE APP - Administrators Mobile No:*4G MOBILE APP - Administrators Email:* Enter Email Confirm Email I CONSENT* I accept the special connection plan conditions:I agree to the minimum connection period as selected. In the event the minimum connection period is not completed I accept there will be an early termination fee. I accept that on the termination of the connection the communicator must be removed and returned to MSE Security Pty Ltd within 7 days at the client's expense or additional charges will apply. The Wireless communicator and SIM card/s remain the property of MSE Security Pty Ltd. CUSTOMER DETAILSClient/Site Name:*Trading as: (if applicable)Site Phone*Site Contact Email* Enter Email Confirm Email Client/Site Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country PROVIDE IMAGES AND PLANS HERE:Please provide a photo of your alarm keypad and floor plans etc so we can assist you promptly and professionally. Drop files here or Select filesMax. file size: 128 MB.Additional Works Required?*If you require additional works conducted in association with this 4G Connection Please confirm the additional services required?No additional works requiredAdd a Routine Maintenance InspectionAdditional works as described belowDescription of Additional Works?Please provide a detailed description of the additional works you require. NOTE: Additional works will be charged at Do & Charge schedule of rates.ACCOUNTS/BILLING INSTRUCTIONSAccounts/Billing Details*Same as Client Details AboveAlternative Accounts/Billing DetailsAccounts Contact First Name*Accounts Contact Last Name*Accounts Contact Email* Enter Email Confirm Email Accounts Contact Phone*Accounts Contact Phone*Accounts Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Consent to MSE Terms of Trade* I have read and agree to MSE Terms of TradeI have read and accept the following: MSE Security P/L T/A MSE Alarms Terms of Trade 1st Oct 2013 COPY HERE https://www.msealarms.com.au/customer-service/terms-of-trade/ALARM MONITORING NOMINATED CONTACTSThe following section is the Nominated Contacts for clients with Remotely Monitored Security Systems only.*Premises Voice ID Code*Premises Voice ID Code is utilised when individual Voice ID Codes are not required for each individual user as defined below. NOTE: Use a secret word (min 4 letters) in combination with a secret number (min 3+ numerals)1. *Nominated Contact*Contact Name:Primary Ph:Secondary Ph:PIN Code:Voice ID Code:2. Nominated ContactContact Name:Primary Ph:Secondary Ph:PIN Code:Voice ID Code:3. Nominated ContactContact Name:Primary Ph:Secondary Ph:PIN Code:Voice ID Code:4. Nominated ContactContact Name:Primary Ph:Secondary Ph:PIN Code:Voice ID Code: Add RemoveIMPORTANT NOTE:* I have read and acknowledge the following IMPORTANT NOTICE.1. A Premises Voice Identification Code is required for all persons that will be contacts for the security of the site, to identify themselves when communicating with our VIP Monitoring Centre. You can share the premises voice ID or individuals can have individual ID’s (Recommend a combination of 2 or 3 Numbers with 2 or 3 letters (EG: AGD-001). Please avoid using birthdays and premises numbers for voice codes as they are too easy to guess. 2. P.I.N Codes are Personal Identification Number Codes that are typically a 4 Digit numeric code for accessing your security system. WARNING: DO NOT USE birth years, birth dates or other easily identifiable numbers as they are easy to guess and will seriously compromise your security. 3. Nominated Contacts in the event of an Alarm condition. We recommend that if you are responsible for taking control of the site’s security, you should be listed as the 1st contact for the site and provide your after hours details. If applicable, you will also need to provide us with the contact names and numbers of other nominated after hours contacts, including the details of their after hours phone numbers. We suggest at least 2 in order of priority including yourself. 4. PRIVATE PATROL RESPONSES In the event of an Alarm and the Nominated Contacts you have provided are not contactable a Private Security Patrol may be dispatched to ensure the security of your premises at a Cost of $75 + GST Per Patrol Attendance 5. IMPORTANT NUMBERS TO NOTE Please save the following phone numbers in all Emergency After-hours contacts phones. MSE Alarms (08) 8235 1001 – Office number to call for any billing queries, service during office hours or transfer to the Emergency Technician, available after-hours (follow the prompts). Monitoring Centre - Contacts 1300 300 823 – If you need to contact the monitoring centre regarding testing your system or following an alarm (accidental activation etc). You will need to have your Voice code ready for the MSE VIP staff to identify you. MSE Monitoring Centre - Caller ID (07) 3722 8990 & (02) 8879 4090 – We recommend that you save these numbers into your mobile phone, so you easily identify that the monitoring centre is calling you. Do not call back on this number as you will only receive a recorded message. Customer Account Type*CREDIT CARD AUTHORITY - Complete Details BelowEXISTING ACCOUNT CUSTOMERNOTE: Invoiced Customers consent to additional charges for late payment in accordance with MSE T.O.T.Credit Card Authorisation I agree to this Credit Card AuthorisationI the cardholder declare all information provided on this form to be true and complete. I acknowledge and agree that I authorise MSE Security Pty Ltd T/A MSE Alarms, to debit the credit card account nominated for all future invoices as they become payable until advised otherwise in writing.Credit CardCardholder NameCard DetailsPLEASE NOTE: On submission of this form a $1.00 charge will be applied to your credit card and subsequently applied to your account.Initial Deposit As A Credit
