Home Security Rebate Program
Feb 10, 2018
submission
#379
Application Form
Applicant Information
| Name | --- |
| Home address (City, State, Zip Code) | --- |
| Best phone number | --- |
| Type of phone | --- |
| Email address | --- |
Demographic Information
| Applicant status | Property Owner |
| Applicant age | 65 years old or over |
| Highest educational level | Associate's Degree |
| Household size | 2 persons |
Tell Us About Your Purchase
| What did you buy? | Video doorbell, Other (please enter description below) |
| Other product | --- |
| How much did you spend? | $15.99 |
| Copy of receipt / invoice | --- |
Show Off Your New Home Security Product
| Photo of installed product | --- |
| Additional photos | --- |
We Need Your John (or Jane) Hancock!
| I agree to the above statement and affirm the validity of everything I have entered in this application. | --- |
Application Review
Staff Review
| Verified Monrovia address? | --- |
| Verified proof of purchase and Installation? | --- |
| Rebate amount | $233.90 |