_ MEDICAL 8: HOME (705) 835-2 500 ALERT STD.. l" P.th BOX 2002, bryLLiA/'oNTAhi6, L3V tiR9 . . " C) [I '2 _7 A E I C] NEW CLIENT LEASE AGREEMENT D NEW CLIENT PURCHASE [Cl RENEWAL _ D CANCELLATION! REBATE Cl OTHER......,.,-..----- . xiv /‘ 1/73,» A)†Cj/l.,,,,..,,,.,.,, '72; _ riei, at, RI???" "ftF5j, // 7 " CITY? 8 POSTAL CODE: c." _," F" , . 1- K7 , â€"â€" R A)" K (:3 / (M p' C /?4’>f//JCL AC?' 5/ A C" 1. D/tu. SERIAL f: TYPE OF UNIT, RO. BOX: “6/ f'icy (5’ a , f MONITORING FEES PAID FROM: 7 A17 esjigiictycs- INSTALLATION CHARGE: ' . -'a r "IW' TO: (iv., 9317/31 MONITORING FEES:, f Itff Jiri? PURCHASE PRICE: SUB TOTAL: l; Cryr . POST-DATED CHEQUES: x = RST.: X = C' 'fjJer' tC" cf-"" PAID BY: I CASH D CHEQUE D POST DATED CANCELLATION REBATE: - BATTERIES REPLACED: C) YES Cl NO PST: - G.S.T. II; RIzissaaaa TOTAL REBATE: IN CONSIDERATION OF THE MUTUAL COVENANTS CONTAINED HEREIN, DEALER AGREES TO LEASE TO SUBSCRIBER AND SUBSCRIBER AGREES TO LEASE FROM DEALER, THE EQUIPMENT HEREIN BEFORE DESCRIBED ON THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE HEREOF, . PER' c" - 1, _ _ I l - ( “TE FIELD iriizr:-sriirsEt-riv_" CUSTOMERS SIGNATURE