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SPONSOR INFORMATION
APPLICATION
ResponseNow Anywhere
IMA#:_____________________________
Monthly Plan
Date:_________________________________
Quarterly Plan
Annual Plan
$39.95 Monthly
Lockbox Option
Lockbox Option
$3.95 Monthly
$3.95 Monthly
Lockbox Option
Included
$89.90
($93.85 with Lockbox Option)
$148.85
($160.70 with Lockbox Option)
$454.40
Yes
Monthly Plan
Quarterly Plan
$89.90
$93.85 with Lockbox Option)
Checking
$148.85
$160.70 with Lockbox Option)
Annual Plan
$454.40
Savings
VISA
American Express
Discover
MasterCard
AWIS272_ResponseNowAnywhere_Application | Rev:07.23.2014
Notify of Transport
Has Keys
Notify of Transport
Has Keys
Notify of Transport
Has Keys
Notify of Transport
Has Keys
RESPONDER
A Responder is able to physically respond to the customer during an alarm activation. Typically
only recommended for a neighbor or someone who lives nearby.
NOTIFY OF TRANSPORT
Whether the person listed should notified in the event a customer is transported from the home
during an emergency.
HAS KEYS
Whether or not the listed person has keys to the customers home.
PARTIES AND SERVICES: The person named as Subscriber and any person
ordering/paying for Services (Payer) or using them (User) (collectively referred
to as Subscriber) hereby contract with ResponseNow Medical Alert Systems
(ResponseNow) for ResponseNow medical alert system monitoring service (Service).
Unless the context otherwise requires, the term Subscriber as used herein refers all
User(s) and Payer(s), and any of them individually. The obligations of Subscriber are
joint and several, meaning that Payer(s) and User(s) are equally, and each individually,
responsible for the obligations of the Subscriber under this Agreement.
The Service includes ResponseNow equipment and monitoring. Equipment means a
ResponseNow Anywhere personal help button (Equipment). Monitoring is provided
through an authorized ResponseNow monitoring center. During the initial and any
renewal term of this Agreement, Equipment remains the property of ResponseNow
and must be returned to ResponseNow at the end of this Agreement as set forth
in Paragraph 2 below. If Subscriber fails to return the Equipment as set forth in
Paragraph 2, Subscriber will be fully liable for the value of the Equipment, which
Subscriber agrees is $250.
ResponseNow may in its sole and absolute discretion and without liability, refrain
from alerting the Responders or advise the Responders of the receipt of oral advice to
disregard the alarm signal.
SUBSCRIBER AGREES THAT ATTEMPTING TO NOTIFY BY THE PHONE DESIGNATED
RESPONDERS IS RESPONSENOWS ONLY DUTY. Subscriber understands and
agrees that: (a) ResponseNow is not responsible for the promptness, sufficiency or
adequacy of the action of any Responder or any third party acting for Responder; (b)
ResponseNow in no way represents or guarantees that Responders can be contacted,
can or will respond, or that any response will be safe or effective; (c) the Responders
have been designated by him or her and are not agents or other representatives of
ResponseNow; and (d) ResponseNow will not send any of its personnel to Subscribers
premises in response to any emergency signal.
2.
TERM & TERMINATION: This Agreement starts when the Agreement is acknowledged
online by the Subscriber or Web-Buyer or when the equipment is activated by the
Subscriber. The original term of this Agreement is the service plan selected above
and will renew for the same consecutive billing cycle thereafter unless terminated
as set forth below. The Agreement will remain in effect for a minimum of THREE (3)
months. After three (3) months it may be terminated by either party by sending the
other party thirty (30) days written notice. ResponseNow may terminate this Agreement
and Services hereunder at any time for non-payment of fees or abuse of the service.
Upon termination, Subscriber will return Equipment to ResponseNow by 1. mailing or
shipping the Equipment to ResponseNow at Subscribers expense (a pre-addressed
return envelope has been provided concurrently with Equipment), or 2. Telephoning
ResponseNow and arranging for pick-up. If Subscriber fails to return Equipment within
thirty (30) days of termination, Subscriber agrees to pay ResponseNow the value of
Equipment which is $250 and which Subscriber hereby authorizes ResponseNow to bill
to Subscribers credit card or bank account or otherwise collect.
3.
The Service includes receipt, analysis and response to alarm signals from Equipment.
Upon receipt of a signal, ResponseNow: (a) will make reasonable effort to promptly
contact Subscriber, and (b) if ResponseNow deems necessary in its reasonable
judgment, notify: (i) persons and entities designated by Subscriber as Responders in
the new order information sheet, in the order designated by Subscriber, or (ii) police,
fire or ambulance designated by Subscriber.
Subscriber agrees that ResponseNow may rely absolutely on the statements of
Subscriber, Responders, or any person who says that they are acting on behalf of a
Responder or Subscriber, with respect to the location and condition of Subscriber.
Subscriber agrees that ResponseNow in its sole and absolute discretion and without
any liability: (a) may contact or attempt to contact the Premises as frequently as
ResponseNow deems appropriate to verify the need to alert Responders; and (b) after
receiving oral advice from anyone at the premises to disregard the alarm signal and
AWIS272_ResponseNowAnywhere_Application | Rev:07.23.2014
and are each bound by its terms, including Paragraphs 14 and 15. By accepting
these terms and conditions, Subscriber, including any User and Payer, each represent
that they are agents of each other. and (a) Subscriber represents and warrants to
ResponseNow that Subscriber has the full power and authority to bind any Payer and
User to these terms and conditions; and (b) each Payer represents and warrants to
ResponseNow that Payer has the full power and authority to bind Subscriber and any
User to these terms and conditions.
4.
5.
Provide and be responsible for suitable electrical outlet for periodic charging
of the Equipment.
B.
C.
D.
E.
F.
G.
Test equipment at least every month with the personal help button following
recommended testing established by ResponseNow;
H.
FEES: Subscriber agrees to pay the periodic fees (monthly, quarterly, or annual)
associated with the Agreement along with any applicable sales tax or for any
additional ResponseNow services later agreed to by the parties. Payments are due in
advance of the period being billed on the anniversary of the activation date. The initial
payment is due upon activation or online transaction completion and is in accordance
with the payment plan selected (monthly, quarterly or annual).
A.
Late Fees: If a payment is not made for any reason (including an expired credit
card or insufficient funds in a checking account), you agree to pay us a late
fee for the administrative cost we incur in the amount of $35.00 for each late
payment, or such lower amount as my be permitted or authorized by law.
Incident), ResponseNow may notify any or all of the parties listed in this Paragraph.
Further, Subscriber releases ResponseNow from all liability, which may arise out of
ResponseNows disclosure of information in this Agreement or about any Incident to
the parties listed in this Paragraph. Subscriber acknowledges that all communications
between Subscriber and ResponseNow Monitoring Center may be recorded and
Subscriber consents tosuch recording.
9.
10. FORCED ENTRY; MEDICAL EXPENSES: Subscriber agrees that if ANY ALARM
SIGNAL is received by ResponseNow and a Responder is sent to Subscribers home
and Subscriber cannot let Responder into the locked home and Responder does
not have a key that THE SUBSCRIBER AUTHORIZED RESPONDER TO BREAK INTO
SUBSCRIBERS HOME. SUBSCRIBER UNDERSTANDS THAT THIS MAY CAUSE DAMAGE
TO THE HOME. SUBSCRIBER WAIVES ANY CLAIM AGAINST RESPONSENOW OR ANY
RESPONDER WHICH MAY ARISE AS A RESULT OF FORCED ENTRY INTO THE HOME.
SUBSCRIBER SPECIFICALLY WAIVES ANY CLAIM FOR DAMAGE RESULTING FROM
FORCED ENTRY AFTER AN INACTIVITY ALARM OR NON-RESPONSE TO A REMINDER
SERVICE EVEN IF SUBSCRIBER IS SIMPLY NOT HOME. In in addition, Subscriber
authorizes ResponseNow to notify paramedics and other appropriate emergency
personnel who may provide medical assistance, if necessary. Subscriber hereby
releases ResponseNow from any and all expenses and liability incurred as a result of
such medical services.
11. ATTORNEYS FEES: In connection with any dispute arising under this Agreement, the
prevailing party shall recover from the other party its reasonable costs and necessary
disbursements and attorneys fees incurred in enforcing this Agreement or otherwise
in connection with any lawsuit, arbitration or other legal proceeding related to or
arising under this Agreement.
12. SUSPENSION OR CANCELLATION OF THE AGREEMENT: Subscriber agrees that
ResponseNow may stop or suspend monitoring service for any of the following reasons:
A.
strikes, severe weather, earthquakes or other such events beyond our control
that effect the operations of the Monitoring Center or so severely damage
Subscriber premises that continuing service would be impractical.
B.
C.
Subscriber does not pay the service charge due to ResponseNow, after
ResponseNow has given Subscriber five (5) days notice that ResponseNow is
cancelling service because of non-payment.
B.
Refunds: Subscriber will not be entitled upon termination to any refund for
Service that are prepaid for monthly, quarterly, annual or other periods.
C.
6.
7.
8.
additional charge. Agreeing to the higher limitation of liability does not mean that
ResponseNow is an insurer.
15. THIRD PARTY INDEMNIFICATION AND NO SUBROGATION: Subscriber agrees
to indemnity and hold harmless ResponseNow, its employees and agents from and
against all and any claims (including by third parties), lawsuits and losses alleged
to be caused by ResponseNows performance, negligent performance or failure to
perform its obligations under this Agreement. If anyone other than Subscriber asks
ResponseNow to pay for any harm or damages (including property damage, personal
injury or death) connected with or resulting from (i) ResponseNows breach of this
Agreement or a failure of Equipment or Service, (ii) ResponseNows negligence, (iii)
any other improper or careless activity of ResponseNow in providing Equipment or
Service, or (iv) a claim for indemnification or contribution, Subscribers agrees and
will pay to ResponseNow (a) any amount which a court or other tribunal orders
ResponseNow to pay or which ResponseNow reasonably agrees to pay, and (b) the
amount of ResponseNows reasonable attorneys fees and any other losses or costs
that ResponseNow may pay in connection with such third-party claim or dispute.
Unless prohibited by Subscribers property insurance policy or other insurance,
Subscriber agrees to release ResponseNow from any claims of any parties suing
through Subscribers authority or in Subscribers name, such as Subscribers
insurance carriers, and Subscriber agrees to defend ResponseNow against any such
claim. Subscriber will notify Subscribers insurance carrier(s) of this release.
16. LIMITATION ON LAWSUITS; WAIVER OF JURY TRIAL: Both ResponseNow and
Subscriber agree that no lawsuit or any other legal proceeding connected with this
Agreement shall be brought or filed more than one (1) year after the incident giving
rise to the claim occurred. In addition, any such legal proceeding shall not be heard
before a jury. EACH PARTY IRREVOCABLY WAIVES ANY RIGHT TO A JURY TRIAL.
17. ENTIRE AGREEMENT/MODIFICATION/CHOICE OF LAW: This Agreement shall
constitute the entire Agreement between Subscriber and ResponseNow. No person
installing, servicing or otherwise dealing with Equipment is or shall be authorized to
act for or bind ResponseNow. This Agreement supersedes all prior representations,
understandings or agreements between the parties. This Agreement may only be
modified in writing signed by both parties. The parties agree that this Agreement will
be governed by the laws of the State of Oregon.
Offered Through:
American Workers Insurance Services 10878 Westheimer Rd., Suite #191, Houston, TX 77042 Phone: 1.866.365.5829 Fax: 1.866.837.4556
AWIS272_ResponseNowAnywhere_Application | Rev:07.23.2014