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Alarm Users Permit Application

2. 

3. Department of Public Safety – Police Division

5. This permit is authorization for an alarm system for the identified location only. Additional sites require additional permits. This permit is not intended to certify operability or effectiveness of the alarm equipment system or any portion thereof. The issuing agency reserves the right to revoke this permit for violations of any state law or ordinance relating to the operation of the alarm system.

6. Please review Alarm Permit Information before completing this application.
   Alarm Permit Information

8. First Name (Business Resident)*

9. Last Name*

11. Address*

13. City*

14. State*

15. Zip Code*

16. Phone Number*

18. First Name (Business Owner/Manager)*

19. Last Name*

21. Address*

23. City*

24. State*

25. Zip Code*

26. Phone Number*

30. BUSINESS HOURS:

32. Mon*
    Mon

    Mon

33. Tue*
    Tue

    Tue

34. Wed*
    Wed

    Wed

35. Thur*
    Thur

    Thur

37. Fri*
    Fri

    Fri

38. Sat*
    Sat

    Sat

39. Sun*
    Sun

    Sun

43. EMERGENCY CONTACTS: (Three are required. List in preferred calling order.)

45. First Name*

46. Last Name*

48. Address*

50. City*

51. State*

52. Zip Code*

53. Phone Number*

55. First Name*

56. Last Name*

58. Address*

60. City*

61. State*

62. Zip Code*

63. Phone Number*

65. First Name*

66. Last Name*

68. Address*

70. City*

71. State*

72. Zip Code*

73. Phone Number*

77. GENERAL INFORMATION:

79. Business Type*
    -- Select One --Bank or Credit UnionSingle ResidenceMultiple DwellingOther

80. Exit Doors?*

    1. North
    2. South
    3. East
    4. West
    5. NE
    6. NW
    7. SE
    8. SW

82. Any Weapons on Premises?*

    1. Yes
    2. No

83. If "Yes," Select Weapons Type

    1. Rifle
    2. Shotgun
    3. Handgun
    4. Other

84. Where are the Weapons Kept?

88. ALARM INFORMATION

90. Date Alarm Installed*
    Date Alarm Installed

91. Alarm Type*

    1. On-Premise Audible?
    2. Monitored by Alarm Company?

93. Alarm Company Name*

94. Phone Number*

96. Address*

98. City*

99. State*

100. Zip Code*

102. Electronic Signature Agreement

     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.
104. Electronic Signature

Leave This Blank:


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

     This field is not part of the form submission.

108. Submit

* indicates a required field