Ditek ACKNOWLEDGEMENT AND REFUSAL OF SURGE

ACKNOWLEDGEMENT AND REFUSAL LIGHTNING PROTECTION is to certify that on 20 I was informed of the need protect my equipment through the recommended use of lightning surge The protection would consist of any and all of the following Coaxial protection to protect my DSS cable serviced products or CCTV Low voltage loop protection to protect my security fire access or other equipment A C Protection installed as either a plug in or hard wire version Phone line protection to protect my modems phones fax equipment consideration of the above recommended protection I have decided to this opportunity to have surge protection devices installed I that utility or lightning surges will not be covered under warranty and assume full and complete responsibility for the of not having the above mentioned devices on premises I agree to hold the installing company harmless and free of obligation in with my decision Authorized Signature Servicing Representative