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billing Form

    Return to SOS Alarm:

    Fax (541) 776-2819
    E-mail:[email protected]

    SOS ALARM
    3273 Biddle Rd
    Medford OR 97504

    Please print address as you wish your bills to appear:

    Account Name *

    Attn;PNB etc

    Mailing Address *

    City/State/ZIP *

    Billing Contact *

    E-mail *

    Account No. *

    Telephone *

    Please Select *

    Name *

    Home Phone *

    Business Phone :

    Address

    Step 1: Cycle

    Monthly (not available if mailed)QuarterlySemi-AnnuallyAnnually

    Monitoring fees are debited on the first day for the ensuing period.

    Billing Method:*

    Electronic Funds Transfer

    Please include a void check

    Account Type:*

    Bank *

    Name on account *

    Routing Number *

    Account Number *

    Will apply to monitoring and service invoices.

    A receipt will be provided to the e-mail address listed above

    Debit or Credit card

    Visa, Mastercard, or Discover only

    Cardholder’s Name *

    Card Number *

    Exp. Date *

    You will receive a form to update at expiration

    Will apply to monitoring and service invoices.

    A receipt will be provided to the e-mail address listed above

    E-mail invoices to above address

    Please sign & Date

    Signature *

    Date:

    sos_Alarm
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