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2. Alarm Information
   Alarm Registration Fee $69 Pay 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 #
37. Address
39. City
40. State
41. Zip Code
43. Does alarm reset automatically?

    1. Yes
    2. No
44. After how long does the alarm reset?
45. Type of Alarm

    1. Audible
    2. Silent
47. 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.
51. Additional Contacts
    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.
53. 1. Name
55. Address
57. City
58. State
59. Zip Code
61. Home Phone
62. Cell Phone
64. Business Phone
68. 2. Name
70. Address
72. City
73. State
74. Zip Code
76. Home Phone
77. Cell Phone
79. Business Phone
83. 3. Name
85. Address
87. City
88. State
89. Zip Code
91. Home Phone
92. Cell Phone
94. Business Phone
98. 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.
100. Electronic Signature
101. Date
     Date
106. 
     
Leave This Blank:


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

     This field is not part of the form submission.

110. Submit Submit and Print

* indicates a required field