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Change of Installer Request Form
SECTION A - End user / Customer details SECTION B - New Security Contractor
Site/Company Name:
Company Name:
Site Address:
Contact Name:
Contact Name:
Contact Phone:
Contact Phone:
SECTION C - Current Security Contractor
Company Name:
Contact Name:
Contact Phone:
SECTION D - End User Statement
I
being the authorised representative for the End User named in SECTION A of
this form wish to advise Inner Range that
wish to appoint the Security Contractor
named in SECTION B as our registered security contractor for the purposes of licence administration in the Inner Range Keypoint
database. We further advise that we require the Keypoint administration privileges of the Security Contractor named in SECTION
C to be removed/retained in addition to the existing Contractor named in Section C. (delete one). Accordingly we herewith
request that Inner Range make the necessary change to our site details in the Inner Range Keypoint database to reflect these
changed circumstances.
Hereby warrants to Inner Range that they are the unencumbered owner of the
complete system and that they have a legal right to make this request. They further warrant to Inner Range that there are no
disputes, legal proceedings or threatened legal proceeding currently in place or foreseen between the End User named in
SECTION A and the Security Contractor named in SECTION C.
In signing this request I also acknowledge and give my authority to Inner Range to action their reserved rights as defined below:
•
Inner Range reserves the right to contact the end user named in SECTION A as a means to establish overall satisfaction with
the security system and to gain a more detailed understanding of the services or lack of services being provided to them by
the security contractors named in SECTION B & SECTION C.
•
Inner Range reserves the right to notify the end user named in SECTION A should it be aware that the Security Contractors
named in SECTION B or SECTION C do not have current Inner Range factory training certification, or do not meet other
regulatory requirements for security industry licensing or qualifications.
•
Inner Range reserves the right to contact the Security Contractor named in SECTION C to ensure that there are no current
disputes, legal proceedings or the threat of legal proceeding foreseen between the customers named in SECTION A and the
Security Contractor named in SECTION C. where issues are identified between the parties, Inner Range reserves the right to
take no action if it might be deemed that the rights of any party to a legal proceeding may be prejudiced by such action.
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Change of Installer Request Form (cont.)
SECTION E - Signed Authority by End User & New Security Contractor
End User Signature of Authorised Representative
Position of Authorised Representative
Name of Authorised Representative
Date
New Security Contractor
Signature of Authorised Representative
Position of Authorised Representative
Name of Authorised Representative
Date
Submit Form Below
Mail
Inner Range
PO Box 9292
Scoresby VIC 3179
Mail
Inner Range
Units 10 - 11
Theale Lakes Business Park,
Moulden Way, Sulhampstead,
Reading, Berkshire RG74GB, UK
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Fax
+61 3 9753 3499
Email
[email protected]
Fax
+44 (0) 845 470 5001
Email
[email protected]