Service Request

Online Service Request

Welcome to our online Service Request Form! This form is designed for both home and business customers to request our top-tier services. Please provide us with some basic information about your service needs, including your contact details and a brief description of the problem you are experiencing. Our team of skilled technicians will review your request and reach out to you promptly to schedule a service appointment. Thank you for choosing our company, and we look forward to serving you soon!

Name

First Name

Last Name

Business Name

If Applicable

Email

Phone

(###)

###

####

Service Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Alarm Account Number (If Applicable):

What is your Alarm Account with Us?

Describe Issue

Please tell us what issues you are experiencing (Hint: Be as detailed as possible)

Are you a Member of our Premium White Glove Service?

This Premium Service requires a subscription of $89.99 p/mo Residential & $149.99 p/mo Commercial

YES

NO

Service Level

What speed of response do you need?

On-Site (Time Is Billed Hourly for non-warranty support)

Phone Support (Time is Billed in 15 minute Increments for non-warranty support)

Speed of Service

Choose your response time. Fees Apply.

Next Available (During Business Hours $199.99 p/h +Tax)

EMERGENCY (During Business Hours $249.99 p/h +Tax)

EMERGENCY (Outside of Business Hours $299.99 p/h +Tax)

TOP PRIORITY EMERGENCY (Current activity Set Aside and a Service Team is Dispatched, Unless Otherwise Impossible due to Circumstances Outside Of Our Control) (1.5 x Regular Service Business Hours/2 x After Regular Business Hours)

I agree to the Terms & Conditions and Undertand that I am Liable for any and all costs associated with hiring Imperial Security & Wiring, inc.

I agree

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