Alarm System Registration

2. Applicant Contact Information

4. First Name*

5. Last Name*

7. Location Address*

9. City*

10. State*

11. Zip*

13. Gate Code (if applicable)

15. Mailing Address

17. City

18. State

19. Zip

21. Home Phone*

22. Cell Phone

24. Business Phone

25. Email Address

29. Alarm Information

31. Alarm Company

32. Alarm Company Phone Number

34. License #

36. Address

38. City

39. State

40. Zip Code

42. Does alarm reset automatically?

    1. Yes
    2. No

43. After how long does the alarm reset?

44. Type of Alarm

    1. Audible
    2. Silent

46. Property Information

    Please indicate the location of any pets, guard dogs, firearms, ammunition, explosives, flammable liquids, poisonous materials or any other hazardous materials on the property to be protected by the security alarm system.

50. Additional Contacts

    All Applications Please Complete The Following: <br> - Please indicate other persons who can be contacted, 24 hours a day, in case of an alarm. <br> - Please list in order you wish individuals be contacted.

    All Applications Please Complete The Following:
    - Please indicate other persons who can be contacted, 24 hours a day, in case of an alarm.
    - Please list in order you wish individuals be contacted.

52. 1. Name

54. Address

56. City

57. State

58. Zip Code

60. Home Phone

61. Cell Phone

63. Business Phone

67. 2. Name

69. Address

71. City

72. State

73. Zip Code

75. Home Phone

76. Cell Phone

78. Business Phone

82. 3. Name

84. Address

86. City

87. State

88. Zip Code

90. Home Phone

91. Cell Phone

93. Business Phone

97. Electronic Signature Agreement*

    I hereby agree to maintain my alarm system in working order and abide by the stipulations as set forth in by the Municipal Code, Section 4-9.303
    
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
99. Electronic Signature

100. Date
     Date

104. Department Action

     Application/Fees Received/Date

106. 
     

Leave This Blank:


107. 1. Receive an email copy of this form.
108. Email address

     This field is not part of the form submission.

109. Submit Submit and Print

* indicates a required field