Request for Dualcom

To guarantee next day delivery, please ensure that your order is submitted by 2pm.

* Required

NAME OF PERSON COMPLETING FORM AND EMAIL ADDRESS FOR CONFIRMATION

Title

First Name *

Last Name *

Email Address *

New Installation / Transfer *
New Installation
Transfer from ARC

If Transfer, from which ARC

If Transfer, please provide SIM / Data Numbers

SIM Number (Transfers Only)

Data Number (Transfers Only)

Residential / Commercial

Sleeping Risk

Reference / Purchase Order No - 12 Characters Max

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Product Type

Aerial Type

Delivery

Standard Signalling / Sia Signalling

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Delivery Address including postcode and contact details:-

Contact Name

Telephone Number

Email Address

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Customer Name

Address

Postcode

Site Telephone Number

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Police Response Required

Police Force

Intruder URN

P/A URN

Fire Brigade Response Required

Fire Brigade

Fire URN

Nimbus Fire Confirmation?

Please note that this is a chargeable extra.

Site Password

Duress Code

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Type of Verification fitted:-

Channel 1 – Type

Channel 1 – Contact Method

Channel 2 – Type

Channel 2 – Contact Method

Channel 3 – Type

Channel 3 – Contact Method

Channel 4 – Type

Channel 4 – Contact Method

Channel 5 – Type

Channel 5 – Contact Method

Channel 6 – Type

Channel 6 – Contact Method

Channel 7 – Type

Channel 7 – Contact Method

Channel 8 – Type

Channel 8 – Contact Method

Channel 9 – Type

Channel 9 – Contact Method

Channel 10 – Type

Channel 10 – Contact Method

Channel 11 – Type

Channel 11 – Contact Method

Channel 12 – Type

Channel 12 – Contact Method

Channel 13 - Type

Polling Fail

Channel 13 – Contact Method

Channel 14 - Type

Network Fail

Channel 14 – Contact Method

Channel 15 - Type

GPRS Fail

Channel 15 – Contact Method

Channel 16 - Type

Line Fault

Channel 16 – Contact Method

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Keyholder 1 Name

Keyholder 1 Telephone Number / Email Address

Keyholder 1 K/H Code

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Keyholder 2 Name

Keyholder 2 Telephone Number / Email Address

Keyholder 2 K/H Code

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Keyholder 3 Name

Keyholder 3 Telephone Number / Email Address

Keyholder 3 K/H Code

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Keyholder 4 Name

Keyholder 4 Telephone Number / Email

Keyholder 4 K/H Code

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Special Actions / Additional Information

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Remote Reset Fitted

Remote Reset - If yes select manufacturer

Alarm Installer

Company Code

Location / Chip No (If known)

Date

Name Of Person submitting this form

Terms and Conditions *
I Accept

I confirm that I am authorized to complete this request on behalf of the Alarm Installer. I / We understand that a binding contract shall be formed in accordance with the Terms and Conditions for the Provision of Monitoring Services

incorporated in the Credit Account Application Form which I / We submitted to EMCS and that this contract shall apply to all services referred to in the Application for Services from the earlier of:

a) the date that EMCS accepts this EMCS Request For Central Station Connection Form and b) the time that I / We first make a connection to the Communication Centre for the services referred to in this EMCS Request For Central Station Connection Form.

Please click here to see our terms and conditions

On completion of this form you will be taken to a confirmation page and given a case number for the request. If you do not receive this number, please contact our admin department.

EMCS

Request for Dualcom

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