Name: ___________________ Date: ______________________

Address: __________________

__________________

Account #: ________________

Attention: ___________________________ (Alarm or monitoring company)

To Whom It May Concern:

Please accept this letter as my notice to cancel alarm monitoring service with your company as of the date stated below.

If I am on a pre-authorized payment system (PAP) this letter also serves as written notice revoking such authorization. A copy of this letter is being sent to my bank or credit card company.

Thank you for your prompt attention to this matter.

End service to my premises as of this date: _________________________________

Yours truly,

___________________________________

(Signature)