billing Form BILLING OPTION 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 * OwnRent/Lease 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 TransferDebit or Credit cardEmail invoices Electronic Funds Transfer Please include a void check Account Type:*CheckingSaving 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: OUR CONSULTANTS will sit down with you to discuss your particular needs and concerns and design a solution catered TO YOUR SPECIFIC NEEDS. CONTACT US