Customer Update Form

Type of Account. (Select One)*

Residential
Commercial

Customer Name*

First Last

Name of person filling out this form*

First Last

Business Name*

Owner or Responsible Person for Business

First Last

Check All The Services You Have With Preventia

Alarm Monitoring
Video Surveillance
Automation / Smart Home
Commercial Fire Monitoring
Access Control

Email*

Premise Address*

What is the address of where equipment is installed and / or monitored.

Street Address Address Line 2 City State ZIP Code

Billing Address*

Same as previous

Current Verbal Passcode

If your alarm is triggered, one of our central station operators will be required to verify your identity. Prior to confirming or canceling dispatch, they will ask you for your PASSCODE. This can be a word or numbers that you give verbally when we call, this can be but does not have to be the same as your 4 digit code used to arm and disarm your system.

New Verbal Passcode

If you would like to update your verbal passcode please enter the new passcode above. (example - This could be a set of numbers or a word)

Call List BEFORE Dispatching Authorities*

Please note: Commercial fire accounts require immediate dispatch before a customer is contacted.

Contact Name Contact Phone #

Call List for Notification AFTER Authorities Have Been Dispatched

Not required

Contact Name Contact Phone #

NEW! GET A TEXT/SMS WHEN YOUR ALARM GOES OFF!

Preventia Chat is a tool to help confirm or disregard a signal. A link is sent out to the user to join a secure chat group with all members on a contact list once a signal is received. Members in the group chat can text one another in the chat to figure out what is going on and decide whether dispatch is needed or not.

Roughly 60 percent of people don’t answer the phone when they receive a call. Preventia Chat allows members to talk on a secure platform without answering the phone. This helps achieve better communication between members on the contact list and resolve an alarm without having to answer the phone.

Preventia Chat is free. Would you like enroll?*

Yes, have someone reach out to me to set this up!
Not right now.

Method of Billing, May We Contact You To Setup Automatic Payments?*

Our Easy Pay Plan allows you to set up automatic bank draft Monthly or Quarterly so you never have to worry about mailing a payment. May we contact you to setup automatic payments?

Yes, I want to save time.
No, thanks.
I'm already enrolled in automatic payments.

May we send you email invoices?*

Yes
No

Customer Information Wellness Update

NEW! GET A TEXT/SMS WHEN YOUR ALARM GOES OFF!

Columbia Office

Lafayette Office

Albany Office

Chattanooga Office