Form Center

2. Resident/Business Name*
3. Location / Alarm Site:*
5. Permit is *

   1. New
   2. Renewal
6. Alarm Site is:*

   1. Residence
   2. Business
   3. Banking Institute
7. Type of Alarm
   -- Select One --SilentAudibleBoth Audible & Silent
9. Permittee Information
11. Name*
12. Date of Birth
    Date of Birth
13. Permit Holder Driver's License # *
15. Cell Phone*
16. Email Address*
18. Billing Address*
20. City*
21. State*
22. Zip Code*
24. Contact Name for Business Alarms
26. Contact Information

    List two additional persons authorized by the permittee to receive, and who have agreed to received, notification that they must come to the Alarm Site within 30 minutes of receiving the notification from the responding emergency personnel.

28. Primary Name*
29. Primary Telephone #*
31. Secondary Name*
32. Secondary Telephone #*
34. I have carefully read the completed application and know the same is true and correct and hereby agree that if a permit is issued, I will comply with all provisions of the City Ordinance #21-01-07-01 and applicable State Laws. I accept responsibility for payment of all fees and fines that result from the operation of the alarm system serving the above premises.
35. Signature*

    By typing your name here, you are signing that you have carefully completed the application

Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field