THE GET HELP FORM – NEXLAR SECURITY

IT IS IMPORTANT TO ACCURATELY REVIEW COMPLETE, AND SUBMIT THIS FORM. AGENTS WILL USE THIS FORM AS A GUIDE TO DETERMINE THE BEST METHOD OF ASSISTANCE, TO CONTACT YOU, AND BOOK A SERVICE DATE. IN ORDER TO PROVIDED EFFECTIVE-QUALITY SERVICE A COMPLETED FORM IS REQUIRED BEFORE AGENTS OFFER SUPPORT.

Primary Name (Last, First M.I)

Primary Contact Number

Primary Email Address

Sec. Name (Last, First M.I)

Sec. Contact Number

Sec. Email Address

Company Name

Address

Cross Street

Security Concern Description, Please Describe Below to the Best of Your Ability.

To the Best of Your Knowledge, When Was The System Installed Keep?

How Will You Pay for the Applicable Service Charges ?

COMPLETED!
Answering all the Questions Above
Constitutes a Completed Form.

Additional Miscellaneous Questions And Information

Alternatives, Please Read the Reduced Rate Options Below.

One (|) Remote Support, only certain Service Request are applicable. Billed at a reduced rate and has a one (I) hour minimum charge. A Authorized Credit Card is requireded prior to actual performance of Support Service. Two (II) Mailing, only certain Service Request are applicable. Client Will be responsible for shipping. Nexlar will cover return shipping up-to ten dollars ($10.00).

Are You Interested to Know if Your Service Concern is Eligible for An Alternative?

Yes

At times, due to Cancelations, We have time-vacancy that may be earlier then Your Booked Service Date. Would you like to be notify of Earlier Bookings?*

Yes