LifeGuardian Account Sign-Up Form

Quickly & easily online sign-up here. If your order is received by 1pm PST, your complete LifeGuardian System ships the same business day!

For a printable/faxable order form, CLICK HERE.

Please Note: * Indicates required field.

Step #1: Tell Us Who Will Be Using The LifeGuardian System
*Subscriber (User) Name:
*Physical Address:
Apartment/Unit #:
Nearest Cross Street:
*City
*State:
*Zip Code:
*Telephone Number: (Include Area Code)
Email Address:
Your Long Distance Company?
How Did You Hear About Us?
Senior Online Super Saver Special: FREE Activation & FREE Ground Shipping
 
Step #2: Choose Your LifeGuardian Service Plan
Annual Plan - Purchase LifeGuardian for $199. Service is $24/mo - paid annually.
Quarterly Plan - Complete LifeGuardian System for only $29/mo - paid quarterly.
Monthly Plan - Complete LifeGuardian System for only $34/mo - paid monthly.
 
Step #3: Tell Us Who Should Be Billed
* Bill To Subscriber                 Bill To Another (complete below)
Full Name:
Billing Address:
City:
State:
Zip Code:
Phone Number:
Email Address:
 
Step #4: Tell Us Your Preferred Payment Method
If you prefer to provide your billing or payment information by telephone, simply leave this section blank and a representative will call you prior to processing your order.
:
Credit Card
Name On Card
Card Number:
Expiration Date:
*Card CVN Number  (3-4 Digit Security Code On Back)
OR
Deduct From Checking Account
Bank Name:
Account Number:
Routing Number:
 
Step #5: Tell Us To Whom We Should Send Your LifeGuardian System
*         
Delivery Name:
Delivery Address:
City:
State:
Zip Code:
Phone Number:
Email Address:
 
Step #6: Choose Popular LifeGuardian Accessories
Key Safe Lock Box ($39 each) - Exterior lockable safe for quick key access.
Extra 400' Wireless Help Button ($4/mo) - Plus pendant, wristband & clip.
Extra 1500' Wireless Help Button ($4/mo) - Includes belt/clothing clip.
Wireless Wall/Hallway Help Button ($4/mo) - Mount anywhere in the home.
Wireless Smoke Detector ($8/mo) - Reports smoke/fire to center.
Wireless CO2 Detector ($8/mo) - Reports presence of CO2 to center.
24 Hour Activity Monitor ($8/mo) - Includes wireless motion detector.
Priority Mail Service ($40) - Shipped next business day by USPS Priority Mail
Expedited Service ($99) - Next day account set-up & Next Business Day Delivery.
 
Step #7: Accept The LifeGuardian Service Agreement
*Agreement Acceptance
*Accepted By (Type Name):
*Date Completed:
*Phone Number:
*Email Address