Account No.

Transaction Type Select One Purchase Lease Add On Takeover

THIS AGREEMENT is made this day of , by and between AMERICAN FIRE & SECURITY SYSTEMS ("COMPANY") AND ("CLIENT")

Phone

Bill to Select One Bill above Bill to other

Subject to the terms and conditions hereinafter set forth, the Company agrees to sell and install in the premises of Client and Client agrees to purchase the following "system":

System Information

The COMPANY further agreees to provide and the Client agrees to purchase MONITORING SERVICES as specified below:

Monitoring Select One 24 Hr Security Monitoring 24 Hr Fire Monitoring24 Hr Fire & Security Monitoring Other If other, please indicate

Monthly Monitoring Fee of Select One $15 $20 $25$30 $35$40$45$50$55 $60$65$70$75$80 Other billed on quarterly basis. If other, please indicate

INSTALLATION $

Contractor's Tax $

Total Cost $

Less Deposit - $

Balance Due Upon Completion of Installation $

Monitoring Fee due for remaining billing quarter $

Monitoring Fee prepayment of upcoming quarter $

Monitoring Tax $

TOTAL COST $

THIS AGREEMENT is for Select One One (1) Two (2) Three (3) Four (4) Five (5) YEARS.

Where Company has not installed equipment, sections 1, 12 and 13 are deleted from Terms & Conditions listed below.

This agreement is not binding unless approved in writing by an authorized representative of Company. In the event of failure of such approval, the only liability of Company shall be to return to the Client the amount, if any, paid to Company upon signing of this agreement. if work cannot b completed due to condiiton beyond the control of Company, progress payments will be made as portions of the installation are supplied or completed. Client acknowledges that Company's liability for damages suffered by Client are limited and liquidated as set forth herein. Client may obtain from Company a higher limiation of Company's liability, if available, by paying an additional periodic charge to Company. See Paragraph 18D.

Some states do not allow limitation on how long an implied warranty lasts or the exclusion of the limitation of incidental or consequential damages, so the above limitation or exclusions may not apply to you. This warranty gives you specific legal rights and you may have other rights which may vary from state to state.

If this is a residential sale, client may cancel this agreement by mailing a notice to the Company. This notice must indicate that Client does not want the goods or services and must be postmarked before midnight of the third business day from the date of this agreement.

~ Client ~

By ____________________________ By _____________

Date __________________________ Date _____________

Approved ______________________

Date __________________________

Purchaser Declines

A. Fire Protection _______________ Initials
B. Service Warranty ______________ Initials
C. Phone Line Protection _________ Initials