Home Security Rebate Program
Feb 22, 2018
submission
#459
Application Form
Applicant Information
| Name | --- |
| Home address (City, State, Zip Code) | --- |
| Best phone number | --- |
| Type of phone | --- |
| Email address | --- |
Demographic Information
| Applicant status | Renter |
| Applicant age | 41-64 years old |
| Highest educational level | Less than a high school diploma |
| Household size | 3 persons |
| Household income | Less than $50,000 |
Tell Us About Your Purchase
| What did you buy? | Video doorbell |
| How much did you spend? | $185.06 |
| Copy of receipt / invoice | --- |
Show Off Your New Home Security Product
| Photo of installed product | --- |
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. | --- |