Service Cancellation Request Dear Valued Customer - Per your request we are sending this cancellation request form. Please be aware that Alert requires that we receive this completed form at least 30-days prior to your requested termination date. If this form is received in our office less than 30-days from your termination date, you may be charged for 30-days of service from the receipt of the completed form. Upon receipt of the completed cancellation form, there will be a complete review of your account. If the terms of your contract have not been fulfilled, you will be charged 80% of the balance of your contract. The exception to this would be if you are moving to a new home and you have signed a contract with Alert for service in your new home. The account review and cancellation will be completed within 5 business days of your termination date. You will be notified by email upon receipt of your completed cancellation form and again upon the completion of the cancellation process and if there is a balance due to Alert or refund due to you. To begin the cancellation process, please follow the link below and complete our online cancellation form which contains fields for vital account information such as your verbal password. For the fields you do not know or have an answer for, you can put "NA", and for the referral email, you can just put your email to allow the cancellation form to submit successfully.Please confirm that you have read the message above by checking the box. *I have confirmed that I read the message above.Name *Name of Business: (if applicable)Email Address *Street Address *Apartment, suite, etcCityState / ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePhone *Cancellation Request Date: (today's date) *Termination of Service Date: *Please note per contract we require 30 days advance notice on cancellation; so you may be billed for current or next month depending on timing of cancellation.Alarm Password *Why are you leaving us? *Moving to another property in IllinoisMoving out of stateI'm not using the alarmOut of businessSwitching to another alarm companyYour prices are too highHardship/cannot pay billCustomer is deceasedDissatisfied with serviceI'm a builder and have sold the propertyIf you're moving, where to?Are you interested in having Alert Protective, Inc. install an alarm or security system at your new home or business? *Please select an optionYesNoIs someone moving into your home or business? *Please select an optionYesNoIf so, and if you make a referral, we can offer you a month of free monitoring at your new home or business. (please provide their contact information below)NamePhoneEmail AddressPlease rank your level of satisfaction with Alert Protective, Inc. on a scale of 1 – 10 (10 highest, 1 lowest) *12345678910Any other feedback for us? *Thank you very much for your business – we are proud to have worked with you as our customer. Regards,The Alert Protective, Inc.Please type ALERT to continue *Submit Cancellation Request