Mobile Alarm setup form

By filling out this form we’ll be able to more quickly setup your mobile alarm. You’re welcome though to call us on 1 877 801 7172 and we can gather this information over the phone.

Personal information

Order number:*
Name on order:*
E-mail:
Name of person wearing pendant:
Location address where the alarm will be worn:
Suburb/Town
State

Emergency contacts

Please include area codes. You can have as many as 5 phone numbers programmed into your alarm. Please remember that mobile phones will receive a Google Map and help text message of the wearers location. You may include 911 as an emergency number.
Phone 1:
Phone 2:
Phone 3:
Phone 4:
Phone 5: