# Personal Emergency Response Systems
- Link: https://www.msealarms.com.au/specials/4g-personal-emergency-response-order-form/
- Published: 2019-01-25T09:29:09+09:30
- Author: mseadmin
## 4G Personal Emergency Response System
* Indicates Required Fields
Company
This field is for validation purposes and should be left unchanged.
**PLEASE COMPLETE THE FOLLOWING FORM AND WE WILL RESPOND PROMPTLY.**
*4G EQUIPMENT OPTION*
NEVERALONE 4G Pendant **$490 ex GST**
TWIG One 4G Handset $990 ex GST
TWIG One 4G Ex Handset $1390 ex GST
QUANTITY REQUIRED?
Confirm the quantity of units required?
Recurring Monitoring Period?*
3 Monthly
6 Monthly
12 Monthly
*NEVERALONE 4G MONITORING*
Monitoring services include 4G SIM Card and data communication costs.
*TWIG 4G MONITORING*
PREMIUM Panic + 2 Way Voice + GPS Location + Tracking $12 ex GST Wk
Client to provide suitable 4G SIM and Service
*NEW SERVICE CONNECTION*
4G CONNECTION + PROGRAMMING + TESTING + DELIVERY $140 + GST
Standard delivery and installations charges allowed for Adelaide Metropolitan area.
NOTE: Installation outside metro area may attract additional charges.
OPTIONAL EXTRAS?
Please provide a detailed description of any optional extras required with your
order.
### **CUSTOMER DETAILS**
Client/Account Name?*
Service/Device User Name?*
Client/User Phone*
The phone number of the individual that relates to the portable emergency response
unit. EG: Mobile for portable device premises landline for base station equipment.
Service Contact Email*
Enter Email Confirm Email
Client/Account Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal
Code Country
SPECIAL REQUIREMENTS?
Describe any special requirement that may affect the operation of this PERS equipment
or Service?
### **REMOTE MONITORING - NOMINATED CONTACTS**
The following section is the Nominated Contacts for clients with Remote Monitoring
and Tracking services activated.
*Voice ID Code*
The Voice ID Code is utilised to identify the user for safety and security reasons.
NOTE: Use a secret word (min 3+ letters) in combination with a secret number (min
3+ numerals)
1. *Nominated Contact*
Contact Name:
Primary Ph:
Secondary Ph:
2. Nominated Contact
Contact Name:
Primary Ph:
Secondary Ph:
3. Nominated Contact
Contact Name:
Primary Ph:
Secondary Ph:
4. Nominated Contact
Contact Name:
Primary Ph:
Secondary Ph:
*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 relating to this service, to identify themselves when
communicating with our VIP Monitoring Centre. You can share the Voice ID or individuals
can have individual ID’s (Recommend a Minimum 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. Nominated Contacts in the event
of an Alarm condition. We recommend that if you are responsible for taking control
of the service's security, you should be listed as the 1st contact for the service
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. 3. IMPORTANT NUMBERS TO NOTE Please save the following
phone numbers in all Emergency After-hours contacts phones. 4. MSE Alarms (08)
8235 1001 – Office number to call for any billing queries, service during office
hours or transfer to Emergency Technical support, available after-hours (follow
the prompts). 5. 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. 6. 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 Trade
I 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/](https://www.msealarms.com.au/customer-service/terms-of-trade/)
### ** PAYMENT OPTIONS**
*Customer Account Type*
NOTE: 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 Authorisation
I 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 and subsequently applied to your account.**
Initial Deposit As A Credit