Application for QUOTED WORKS Application for QUOTED WORKS PLEASE COMPLETE THE FOLLOWING FORM AND WE WILL RESPOND PROMPTLY. CLIENT/SITE DETAILSClient/Site Name:* Site Phone* Site Contact Email* Trading as: (if applicable) Client/Site Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican 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 RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint 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 TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country ACCOUNTS/BILLING DETAILSAccounts Contact First Name* Accounts Contact Last Name* Accounts Contact Phone*Accounts Email Address* Required FieldCONFIRMATION OF WORKSConfirm Quoted Works*Please confirm the exact options you require as follows:Proceed with all Quoted OptionsProceed with the Options described in detail belowQuote No?*Provide Quote Number nad/or Salesperson's name Described All Options Required:If you do not require each and every quoted option you must clearly describe the required options below:4G MONITORING/SELF NOTIFICATION* Required Not Required 4G WIRELESS CONNECTION PLAN* A. Quoted Connection Fee with Min 36 Month commitment B. Quoted Connection Fee with Min 24 Month commitment C. Quoted Connection Fee with Min 12 Month commitment D. Quoted Connection Fee with No Lock In Period E. No Wireless Connection Plan Required ALARM COMMUNICATOR CONSENT* In the event a communicator is provided I consent to these conditions: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.*4G ALARM MONITORING REQUIRED* Basic Class 2 (1 x SIM) PREMIUM Class 2 (1 x SIM) + Mobile Notify App PREMIUM Commercial Class 2+ (2 x SIM) + Mobile Notify App HIGH SECURITY Class 3 (2 x SIM) + Mobile Notify App Mobile Notification App Only (No Remote Monitoring) Recurring Monitoring Invoice Frequency?* 3 Monthly 6 Monthly 12 Monthly 4G MOBILE APP - Administrator's Name:*NOTE: Administrator has the authority to add, edit or remove all other App users. 4G MOBILE APP Administrator's Mobile:* 4G MOBILE APP Administrator's Email:* 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: IMPORTANT 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. 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/ PAYMENT OPTIONSCustomer Account Type*CREDIT CARD AUTHORITY - Complete Details End Of FormFULLY INVOICE IN ADVANCE - Payment Before Commencing WorksEXISTING CREDIT ACCOUNT CUSTOMERNOTE: A deposit of 40% will be charged before commencing quoted works.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 Card Cardholder Name Card Details PLEASE NOTE: On submission of this form a $1.00 charge will be applied to your credit card for verification purposes and credited to your account.Initial Deposit As A Credit*EmailThis field is for validation purposes and should be left unchanged.