ALARM USER PERMIT APPLICATION
Please Complete and Submit the Application below
All Data Fields are Required, except where otherwise indicated
Application Type:
New
Renewal
Change
Revoked Renewal
Applicant's Information
Owner's Name:
E-Mail Address:
Street Address:
Post Office Box:
Home Phone:
Work Phone:
Alarm Information
Address of Alarm Location:
Phone No. at Alarm Location:
Alarm Type
(Optional)
:
Local
Direct Connect
Dialer
Central Station
Alarm Class(es):
:
Police
Fire
Medical
Alarm Seller:
Alarm Seller Telephone Number:
Alarm Installer:
Alarm Installer Telephone Number:
Alarm Monitoring Company:
Alarm Monitoring Telephone Number:
Additional Information
(Optional)
:
Visual Handicap
Orthropedic Handicap
Other Handicap
Hearing Impaired
Emergency Contact Information
1st Contact:
Home Phone:
Work Phone:
2nd Contact:
(Optional)
Home Phone::
Work Phone:
3rd Contact:
(Optional)
Home Phone:
Work Phone:
Applicant's Signature:
___________________________________
Date:
______________________
Office Use Only
Date Received:
Action:
Permit Number:
Expiration Date:
Fee: $
Date Paid:
©New Castle, NH Police Department
