Place Your Order Here

• 1. Select Product:

  Product

  •  Fall Detection
  •  Classic Home System
  •  Mobile Medical Alert

  Please select a Service Type

  Billing Frequency

  •  Annual
  •  Quarterly
  •  Monthly

  Please select a Plan Type

  Shipping Method

  •  1-5 Business Days$15.95
  •  2 Day Shipping$19.95
  •  Next Business Day$59.95

  Please select a Service Type

  Total

  Activation Fee: $0.00 Total with shipping and tax: $0.00

  Next
• 2. Credit Card Info:
  • * Card Type: Please Select... Discover Mastercard Visa
  • * Card Number: American Express not accepted.
  • * Exp. Month: MM 01 02 03 04 05 06 07 08 09 10 11 12
  • Exp. Year:
  • * CID:

  

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• 3. Billing and Shipping Info:
  • * First Name:
  • * Last Name:
  • * Phone:
  • * Email:
  • * Address:
  • Address 2:
  • * City:
  • * State: Please Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  • * Zip:

   Shipping different from billing

  • * First Name:
  • * Last Name:
  • * Phone:
  • * Address:
  • Address 2:
  • * City:
  • * State: Please Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  • * Zip:
  • * Email:

  Previous Checkout & Create Profile

  On the next page you will fill out information about the person using the system and customize the responder settings.

• 4. User Info:
  • * User First Name:
  • * User Last Name:
  • * Primary Phone:
  • * Primary Phone Type: Please Select... Home Cell
  • * Home Phone Service: Please Select... Tone Pulse/Rotary VOIP Cell Phone Only
  • * Address:
  • Address 2:
  • * City:
  • * State: Please Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  • * Zip:
  • * County:
  • * Nearest Cross Street:
  • * Date of Birth:
    Month
    1 2 3 4 5 6 7 8 9 10 11 12
    
    
    Day
    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
    
    
    Year
    

  Next
• 5. Emergency Responder:
  • * Name:
  • * Relationship to user: Please Select... Relative Neighbor Friend Caseworker Other
  • * Phone:
  • * Type of Phone: Please Select... Home Cell Work Other

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• 6. Who should be called first if the user is unable to answer?
  Please Select... EMS First (Recommended) Responders First

  Special Notes:

  If you would like to add additional responders or setup notifications, please call 1-866-802-3676 when your system arrives

  Previous Update User Details & Complete Order
• Thanks for your order!