Alarm System Registration

2. PAYMENT INFORMATION
   Alarm Registration Fee $68 Alarm Renewal Fee $44 Payments accepted by mail or in person

   Alarm Registration Fee $68 Alarm Renewal Fee $44 Payments accepted by mail or in person

4. Applicant Contact Information

6. First Name*

7. Last Name*

9. Location Address*

11. City*

12. State*

13. Zip*

15. Gate Code (if applicable)

17. Mailing Address

19. City

20. State

21. Zip

23. Home Phone*

24. Cell Phone

26. Business Phone

27. Email Address

31. Alarm Information

33. Alarm Company

34. Alarm Company Phone Number

36. License #

38. Address

40. City

41. State

42. Zip Code

44. Does alarm reset automatically?

    1. Yes
    2. No

45. After how long does the alarm reset?

46. Type of Alarm

    1. Audible
    2. Silent

48. 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.

52. 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.

54. 1. Name

56. Address

58. City

59. State

60. Zip Code

62. Home Phone

63. Cell Phone

65. Business Phone

69. 2. Name

71. Address

73. City

74. State

75. Zip Code

77. Home Phone

78. Cell Phone

80. Business Phone

84. 3. Name

86. Address

88. City

89. State

90. Zip Code

92. Home Phone

93. Cell Phone

95. Business Phone

99. 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.
101. Electronic Signature

102. Date
     Date

106. Department Action

     Application/Fees Received/Date

108. 
     

Leave This Blank:


110. 1. Receive an email copy of this form.
111. Email address

     This field is not part of the form submission.

112. Submit Submit and Print

* indicates a required field