Vital Link - Request More Information

Online Order Form

Choose a Product
Purchase a lockbox (cost: $45) (CA residents + Tax)

Client Information

Date of Birth

Name

First
Last

Contact Information

Address

City

State

Zip code

Phone Number

E-mail address

Ship To Address (if different than above)

Address

City

State

Zip code

Phone Number

Contacts and key-holders to be called until one is reached

1.

Name:

Phone1:

Phone2:

Phone3:

Key-holder

2.

Name:

Phone1:

Phone2:

Phone3:

Key-holder

3.

Name:

Phone1:

Phone2:

Phone3:

Key-holder

4.

Name:

Phone1:

Phone2:

Phone3:

Key-holder

5.

Name:

Phone1:

Phone2:

Phone3:

Key-holder

Other Information

Hospital

Phone:

1. Doctor:

Phone:

2. Doctor:

Phone:

Medical Conditions:

Directions to client's home and cross street:

Billing Information

Send Bill to:

Billing Information

First Name

Last Name

Address

City

State

Zip code

Phone Number

Submitting this form gives rescue permission to enter my house if no key is available at the time of the emergency. I also certify that the above monitoring data is correct. I understand any changes to this data must be made in writing to Bay Area Vital-Link, Inc. I further understand that Vital Link's liability is limited and is not obligated to monitor until a signed copy of the system agreement is received. I have reviewed it and agree to the terms.

Call Today
(800) 752-5522 - Toll Free
(510) 644-2779
(510) 548-7501 - Fax
Email: info@vital-linkinc.com

Vital Link Business Reliability Report

Vital Link Featured on Extreme Makeover Home Edition
Arthur Hoffman, Executive Director of Vital Link
As featured on
ABC's "Extreme Makeover: Home Edition"

Click here for
Press Release

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