PROFESSIONAL
SECURITY INC  
MOBILE SECURITY
TOWERS

New Customer Paperwork

Thank you for choosing MST. We are excited to work with you. In an effort to expedite the timeline to receive your equipment, please complete the attached forms and return to jpmorgan1964@gmail.com ASAP.

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* RENTAL CONTRACT

* Accounts Payable Contact/Tax

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* Certificate of Insurance Requirements Credit Card Authorization

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If you have any questions please contact your regional sales manager or call 239-340-2253.

Thank you.

MOBILE SECURITY TOWERS RENTAL CONTRACT 

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Company name:

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Phone:                                                    Fax:                                                 E-mail:

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Registered company address:

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City:

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State:                            ZIP Code:

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Number of Years in Business:

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FEID:

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Sole proprietorship:                                            Partnership:

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Corporation: Other:

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BUSINESS AND CREDIT INFORMATION

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Primary business address:

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City:                                               State:                                                    ZIP Code:

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How long at current address?

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Telephone:                                                            Fax:                                                   E-mail:

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Type of Industry:

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Estimated Annual Sales:

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Bank name:

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Bank address: Phone:

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City:                                                                       State:                                                          ZIP Code:

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Bank Contact:

 

PLEASE PROVIDE THREE BUSINESS/TRADE REFERENCES

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Company name:

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Address:

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City:                                                            State:                                                       ZIP Code:

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Phone:                                                       Fax:                                                           E-mail:

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Type of account:

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Company name:

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Address:

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City:                                                            State:                                                       ZIP Code:

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Phone:                                                       Fax:                                                           E-mail:

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Type of account:

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Company name:

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Address:

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City:                                                            State:                                                       ZIP Code:

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Phone:                                                       Fax:                                                           E-mail:

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Type of account:

 

Accounts Payable Contact Information

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Name:   

                                                                                                EMAIL:

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Phone:                                                                                                 Address:

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Are purchase orders required:                                                       Taxpayer ID:

 

AGREEMENT

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By submitting this application, you authorize PROFESSIONAL SECURITY INCl to make inquiries into the banking and business/trade references that you have supplied, as well as periodic credit checks

Title                                                                                                         Date:

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Printed Name: 

                                                                                      Signature:

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By submitting this application, you authorize MOBILE SECURITY TOWERS to make inquiries into the banking and business/trade references that you have supplied, as well as periodic credit checks.

 

SIGNATURE

Title:
Printed Name:

Date:                                                                    Signature:

 

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Credit Card Payment Authorization Form

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Sign and complete this form to authorize MST to make a one-time or recurring debit to your credit card.

By signing this form you give us permission to debit your account for the amount indicated on or after the indicated date.

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ADDITIONAL 4% WILL BE ADDED FOR CC FEES AND PROCESSING:

 

Please complete the information below:

Select One: ☐ One Time Payment ☐ Use card for Recurring Payments

Account Type: ☐ Visa ☐ MasterCard ☐ AMEX ☐ Discover Account Number:_____________________________________________

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Cardholder Name __________________________ Signature:____________________________

City, ____________________State,______________ Zip ____________ Expiration Date ​____________

Code (3 digit number on back of Visa/MC/Discover, 4 digits on front of AMEX) ​_________

Phone #__________________ Email address for Receipt______________________

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time or recurring use, as indicated on this form. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

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Authorized Representative Name: ___________________________

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Signature:___________________________________________Date:________________________

 

 

MST Use Only:

SalesForce Opportunity#:_______________________ SSR Sales Rep Name:_______________________

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MST provides the most advanced remote video monitoring services in the industry. We proactively stop most crime, and are quick to contact law enforcement when necessary. Across the last 12 months, our system continually performs for customers.



 

Recurring Credit Card Payment Authorization Form

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Sign and complete this form to authorize PROFESSIONAL SECURITY INC / MOBIL SECURITY TOWERS to recurring debits to your credit card listed below.

By signing this form, you give PROFESSIONAL SECURITY INC / MOBIL SECURITY TOWERS permission to debit your account for the amount indicated on each recurring invoice. This is permission for each subsequent transaction.

Please complete the information below:

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I ​____________________________​ authorize PROFESSIONAL SECURITY INC / MOBIL SECURITY TOWERS  to charge my credit card ​(full name)

account indicated below at the beginning of each rental period. These payments are for rental of PROFESSIONAL SECURITY INC / MOBIL SECURITY TOWERS  equipment.

Billing Address ____________________________ Phone#________________________ City, State, Zip ​____________________________ Email ________________________

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for recurring use. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card

company; so long as the transaction corresponds to the terms indicated in this form.

SIGNATURE _________________________ DATE ______________________

​Account Type: ☐ Visa ☐ MasterCard ☐ AMEX ☐ Discover

Cardholder Name _________________________________________________ Account Number _____________________________________________ Expiration Date ​____________

CVV2 (3 digit number on back of Visa/MC, 4 digits on front of AMEX) ​______
Please provide a copy of this form to your Street Smart Sales Rep upon completion.

 

MST Use Only:

SalesForce Reference #:_______________________ SSR Sales Rep Name:_______________________

 

Insurance Requirements

As a customer of PROFESSIONAL SECURITY / MST TOWERS  we are requiring that you provide us with evidence of insurance that meets the minimum requirements outlined below. 

Commercial General Liability (Occurrence Form) Each Occurrence

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Each Occurrence $1,000,000 

Damage to Rented Premises (Each Occurrence) $100,000 

Med Exp (Any one person) $5,000 

Personal & Advertising Injury Liability $1,000,000 

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PROFESSIONAL SECURITY INC/ MOBILE SECURITY TOWERS 208 4TH STREET FT MYERS FLORIDA 33907  named as Additional Insured on a primary and noncontributory basis. Waiver of Subrogation in favor of

 

PROFESSIONAL SECURITY INC
30 days’ Notice of Cancellation (NOC) in favor of PROFESSIONAL SECURITY INC.

The above coverage must be placed with an insurance company with an A.M. Best rating of A-:VII or better. The certificate shall provide that the insurer SHALL mail notice of any cancellation or reduction of the insurance to the Additional Insured at least 30 days in advance of the effective date of any cancellation or reduction.

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Initial to confirm the lessee carries the insurance required for the rental as outlined : X____________

Certificate must be forwarded to the email address below before the rental can begin.Email: sales@mst247.com

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MST  Use Only:

SalesForce Opportunity#:_______________________ SSR Sales Rep Name:_______________________

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