Device Order Form - Summit Realty

Name of the Person Ordering*

Contact Number*

Email Address*

Address of the Strata Company*

Strata Plan Number

Lot Number*

Pedestrian fob - please select

Remote - please select

Key - please select

Quantity required

Is this a new device order rather than lost or stolen?

Lost/Stolen Device?

If lost or stolen please advise reason for replacement.

Lost or stolen device number

Police Report Number (if stolen)

Method of Collection*

Address for delivery (if selected above)

If collecting, please advise name of the person collecting. ID required for Summit Realty office collection.

By completing and submitting this form, you accept full responsibility and authorise all charges associated with this order to be billed to the Lot Owner’s account. You will receive an invoice by email for the payment of the access device (and other charges if applicable). Please note that the device will not be released until payment has been received in the Summit Realty account. Check the tick box below to proceed.