Applicants Name: Address: Phone Numbers: Day: Night: Address of Premises upon which the alarm system is/or will be located: Premise Type: Residence and/or Business Alarm Type: Burglar Fire Medical Emergency Self-contained Audible Security Monitored Security Company Name (if applicable): Security Company Address: Security Company Phone Number: Persons that may be contacted in the event of an activation or emergency. 1. Name: Address: Phone Number: 2. Name: Address: Phone Number:
PLEASE BE ADVISED THAT IT IS YOUR RESPONSIBILITY TO LET YOUR SECURITY COMPANY KNOW ABOUT YOUR ADDRESS CHANGE. Please provide your security company with the following emergency numbers. Please Note: These numbers are for ALARM COMPANIES ONLY. FIRE/EMS ALARM: (609) 265-7168 POLICE ALARM: (609) 265-7169
Fee: $15.00 (The following part of this form is to be filled out by the Police Department ONLY.) Approved By: __________________________________________________ Date Approved: ________________________________________________