Alarm User Registraton

2. Farmington Police Department Alarm User Registration Form

4. Name of User:*

   Name of Business, if residence, name of two adults

6. Person in Control:*

8. Date of Birth (User):

   First Adult

9. Date of Birth (Person In Control):

   Second Adult

11. Alarm Location*

    1. Residence

    1. Business

    1. Financial

    1. Government

13. If Residence

    1. House

    1. Condominium

    1. Apartment

    1. Other

14. If Business, type of Business:

16. Street Address*

18. Nearest Cross Street

20. City*

21. State*

22. Zip*

24. Main Phone

25. Phone (#1 A)

26. Phone (#1 B)

28. Mailing Address, if different from Street Address

30. System Information*

    1. New System

31. Installation Date
    Installation Date

32. System Information

    1. Existing System

33. Installation Date
    Installation Date

35. Type of Burglary Alarm System (check only one):*

    1. Audible Only (system sounds a siren/bell only)

    1. Monitored Only (system signals alarm company only)

    1. Both Audible and Monitor

37. Type of Burglary Alarm System (check only one)

    1. Audible Only (system sounds a siren/bell)
    2. Monitored Only (system signals alarm company only)
    3. Both Audible and Monitored

39. Name of Alarm Monitoring Company:

40. 24 Hour Telephone:

42. Name of Installation/Service Company:

43. 24 Hour Telephone:

45. Type of User Activated Alarms:*

    1. Robbery/Holdup (a silent signal only is sent to the alarm company)

    1. Panic (a silent/bell sounds at the location and a silent signal is also sent to the alarm company)

    Check appropriate box(s) if a user of the alarm system can activate these special emergency conditions even when the burglar alarms system protecting the premises is turned off.

47. Type of Other Emergency Signals:

    1. Fire Alarm

    1. Medical Alert

49. List two people other than user and person in control who can be contacted with keys to the premises to assist police and/or fire to secure the premises or reset a malfunctioning alarm (must list two)

51. Name:*

52. Address

54. Date of Birth

55. Phone

56. Alternate Phone

58. Name:*

59. Address

61. Date of Birth

62. Home Phone

63. Alternate Phone

65. Instructions to help officers respond/search your premises (example: directions, guard dog, etc.):

67. Authorized Electronic Signature:*

68. Date:*

Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit

* indicates a required field