Alarm Users License Application (Alsip PD)

Village of Alsip
Alarm Users License Application
For Burglar and Hold Up / Panic Alarms

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Resident or Business Name*
Address of Alarmed Premise*
Street Address Address Line 2 City State ZIP Code
Apartment / Unit / Condo Number
Telephone Number*
Fax Number
Where is Alarm Located ?*
- House
- Condo
- Apartment
- Commercial
- Institutional
Is the Alarm Equipped with a Hold Up / Panic Feature ?*
- Yes
- No
Type of Alarm System (Check all that Apply)*
NOTE : Voice Tape Direct Dialers Are NOT Permitted.
- Direct Wire to the Alsip Police Department
- Central Receiving Station
- Outside Ringer
- Inside Ringer
Contact Person the Alsip Police Department should mail false alarm notices to, or contact if there is a problem with the alarm:
Name*
Business Phone*
Extension
Name of Alarm System Service Company*
Telephone Number*
Persons to be Contacted if There is a Problem when the premise is Vacant:*
(These persons should have a key to the premise and know how to reset or deactivate the alarm)

Click ⨁ to add additional entries
Name Telephone Number Pager/Cellular Number
Name*
Date*
MM slash DD slash YYYY
Signature

Name	Telephone Number	Pager/Cellular Number