Homeowner’s Insurance Certificate

Please note that the services listed above are basic services that ADT Security Services, Inc. provides and may not reflect any additional monitoring options. If there are any questions regarding the information provided, please contact ADT at 1-800-ADT-BILL or send correspondence to the following address:
ADT Account Services
P.O. Box 551200
Jacksonville, Florida  32255-1200

Insurance Agent:
Name  ________________________________
Tel.  ______________________________
Address  ______________________________
City  _______________________________
State __________________
Zip  __________________

ADT Customer Information:
Name  ________________________________
Tel.  ______________________________
Address  ______________________________
City  _______________________________
State __________________
Zip  __________________
This system has been active as of _____________________
Date  ________________________