Fax/Mail Order Form

Print this form to fax or mail. Allow two to four weeks for delivery.
Orders sent via Ground Transport. Special handling is available.

Mail:	InstantSecuritySystem.com	Fax: 619-595-0162
	6549 Mission Gorge Rd #205
	San Diego, CA 92120

First Name ________________________________ Last Name ________________________________ Email ____________________________________ Company(Optional) _________________________ Address __________________________________ City _____________________________________ State ____________________________________ Zip/Postal Code ___________________________ Country _________________________________ Phone __________________________________

[__]Visa    [__]American Express [__]MasterCard    [__]Discover Credit Card Number __________________________ Name on Card ___________________________________ Expiration Date _____________ CV2_______ Signature _________________________________

Or Call 866-298-2857 with your card number and order information ready.

Qty	Products / Services	Unit Price	Subtotal
	Basic Starter Kit (includes 1 Master Alarm, 1 Wireless Detection Unit, 2 Key Chain Remotes)	$199.99
	Wireless Detection Unit	$59.99
	Key Chain Remotes (package of 2)	$55.99
	Sparrow (for VOIP phone service)	$129.99
	Cyclone (for wireless monitoring)	$229.99
Months	24/7 Monitoring	Unit Price	Subtotal
	Standard 24/7 Monitoring	$19.95
	Cyclone 24/7 Wireless Monitoring	$29.95
	Sparrow 24/7 VOIP Monitoring	$29.95
	Bonus month (for each Basic Starter Kit plus full year of monitoring - purchased by someone you refer)	Free
We will reply by telephone to confirm your order and payment instructions.
		Shipping
		Sales Tax
Total	Grand Total	Total:
Referrals: First Name ________________________________ Last Name ________________________________ Email ____________________________________ Phone __________________________________ First Name ________________________________ Last Name ________________________________ Email ____________________________________ Phone __________________________________ First Name ________________________________ Last Name ________________________________ Email ____________________________________ Phone __________________________________